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General NPI Number Information
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NPI Number | 1306705728
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Entity Type | Individual
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Provider Name | CLIFT ROACH II
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Gender | Male
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 7111 W OUTER DR
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City | DETROIT
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State | MI
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Zip | 48235-3168
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Country | US
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Telephone | 313-850-5474
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Fax |
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Provider Business Mailing Address
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Address Line | 19451 WESTMORELAND RD
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City | DETROIT
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State | MI
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Zip | 48219-2144
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Country | US
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Telephone | 313-850-5474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | MI
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