Healthcare Provider Details

I. General information

NPI: 1043472665
Provider Name (Legal Business Name): ROBERT FRANCIS ROOT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13750 S SEDONA PKWY STE 2
LANSING MI
48906-8101
US

IV. Provider business mailing address

804 SERVICE RD STE A202
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-4000
  • Fax: 844-722-4112
Mailing address:
  • Phone: 517-353-4000
  • Fax: 844-722-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101017720
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: