Healthcare Provider Details

I. General information

NPI: 1528756897
Provider Name (Legal Business Name): BENJAMIN ROSHAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

3550 TERRACE ST
PITTSBURGH PA
15213-2500
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-2000
  • Fax:
Mailing address:
  • Phone: 412-647-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOT024949
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5151016006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: