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General NPI Number Information
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NPI Number | 1881904241
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Entity Type | Organization
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Legal Business Name | KURT M. ROECKER, D.O., P.C.
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 14930 LAPLAISANCE RD SUITE 118
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City | MONROE
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State | MI
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Zip | 48161-3880
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Country | US
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Telephone | 734-240-2892
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Fax | 734-240-2912
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Provider Business Mailing Address
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Address Line | 14930 LAPLAISANCE RD SUITE 118
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City | MONROE
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State | MI
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Zip | 48161-3880
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Country | US
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Telephone | 734-240-2892
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Fax | 734-240-2912
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Authorized Official
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Title or Position | OWNER
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Name | DR. KURT M ROECKER
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Credential | D.O.
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Telephone | 734-240-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101013387
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License Number State | MI
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