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General NPI Number Information
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NPI Number | 1962780767
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Entity Type | Organization
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Legal Business Name | VILLAGE PEDIATRICS PLLC
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 31815 SOUTHFIELD RD SUITE 14
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-644-5626
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Fax | 248-644-5497
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Provider Business Mailing Address
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Address Line | 31815 SOUTHFIELD RD SUITE 14
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-644-5626
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Fax | 248-644-5497
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HERBERT J ROTH
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Credential | M.D
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Telephone | 248-644-5626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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