Provider Demographics
NPI:1043472665
Name:ROOT, ROBERT FRANCIS (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:ROOT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-4000
Mailing Address - Fax:844-722-4112
Practice Address - Street 1:13750 S SEDONA PKWY STE 2
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-8101
Practice Address - Country:US
Practice Address - Phone:517-353-4000
Practice Address - Fax:844-722-4112
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2023-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017720208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043472665Medicaid
MIC36082146Medicare PIN