Healthcare Provider Details

I. General information

NPI: 1487232559
Provider Name (Legal Business Name): ANITA ROVERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANITA KAMATH

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2689
US

IV. Provider business mailing address

1349 S ROCHESTER RD STE 100
ROCHESTER HILLS MI
48307-3151
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8144
  • Fax: 313-916-7548
Mailing address:
  • Phone: 248-759-5460
  • Fax: 248-923-2446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301511911
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301511911
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: