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General NPI Number Information
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NPI Number | 1033323712
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Entity Type | Organization
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Legal Business Name | HERBERT J. ROTH JR. MD PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 W. BIG BEAVER RD SUITE 1060
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City | TROY
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State | MI
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Zip | 48084-4100
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Country | US
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Telephone | 248-457-9190
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Fax | 248-457-9188
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Provider Business Mailing Address
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Address Line | PO BOX 67000 DRAWER 242401
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City | DETROIT
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State | MI
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Zip | 48267-2424
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Country | US
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Telephone | 248-457-9190
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Fax | 248-457-9188
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. HERBERT J. ROTH JR.
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Credential | M.D.
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Telephone | 248-457-9190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301407009
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License Number State | MI
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