Healthcare Provider Details

I. General information

NPI: 1811939242
Provider Name (Legal Business Name): BERNARD A ROEHR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/27/2023
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST SUITE M-424
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST SUITE M424
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-3350
  • Fax: 269-349-2403
Mailing address:
  • Phone: 269-349-3350
  • Fax: 269-349-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301051166
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number4301051166
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: