Healthcare Provider Details

I. General information

NPI: 1265513907
Provider Name (Legal Business Name): MR. ROGER W. ARMITAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14148 C DR
PLYMOUTH MI
48170-2306
US

IV. Provider business mailing address

14148 C DR
PLYMOUTH MI
48170-2306
US

V. Phone/Fax

Practice location:
  • Phone: 248-444-9998
  • Fax:
Mailing address:
  • Phone: 248-444-9998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: