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General NPI Number Information
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NPI Number | 1992348197
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Entity Type | Organization
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Legal Business Name | EDWARD ROBERTS PLLC
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 15000 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48205-1973
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Country | US
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Telephone | 313-307-4967
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Fax |
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Provider Business Mailing Address
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Address Line | 25146 LINDENWOOD LN
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City | SOUTHFIELD
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State | MI
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Zip | 48033-6103
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Country | US
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Telephone | 248-497-1399
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD ROBERTS
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Credential | MD
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Telephone | 313-307-4967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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