Healthcare Provider Details

I. General information

NPI: 1023005659
Provider Name (Legal Business Name): HAROLD FRANKLIN ROTH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 LAKE LANSING RD SUITE 200
LANSING MI
48912-3788
US

IV. Provider business mailing address

1627 LAKE LANSING RD SUITE 200
LANSING MI
48912-3788
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-1789
  • Fax: 517-485-2357
Mailing address:
  • Phone: 517-485-1789
  • Fax: 517-485-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101007838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: