Healthcare Provider Details

I. General information

NPI: 1093746208
Provider Name (Legal Business Name): JEFFREY ALAN ROCHLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N MAIN ST
ROYAL OAK MI
48067-1840
US

IV. Provider business mailing address

26901 BEAUMONT BLVD # 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-543-8111
  • Fax: 248-543-8120
Mailing address:
  • Phone: 947-522-1952
  • Fax: 947-522-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301070068
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301070068
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: