Provider Demographics
NPI:1053309393
Name:ROECKER, KURT M (DO)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:M
Last Name:ROECKER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:14930 LAPLAISANCE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3880
Mailing Address - Country:US
Mailing Address - Phone:734-240-2892
Mailing Address - Fax:734-240-2912
Practice Address - Street 1:14930 LAPLAISANCE RD
Practice Address - Street 2:SUITE 118
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3880
Practice Address - Country:US
Practice Address - Phone:734-240-2892
Practice Address - Fax:734-240-2912
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0855811754OtherBCBS OF MICHIGAN
MI4506636Medicaid
MION71250Medicare ID - Type Unspecified
MI4506636Medicaid