MEDICARE: THOMAS PATRICK ROESKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	3501008994	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891845335	OTHER	MI	NPI

General Provider Information

NPI Number	:	1033774302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS PATRICK ROESKE

Provider Business Mailing Address
First Line	:	22777 KELLY RD
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-2036
Country	:	US
Telephone Number	:	586-773-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 N MAIN ST STE 120
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1187
Country	:	US
Telephone Number	:	248-656-9516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/02/2019

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Directions to “ THOMAS PATRICK ROESKE ” Practice Location

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