Provider Demographics
NPI:1093746208
Name:ROCHLEN, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:ROCHLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD # 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1952
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:950 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1840
Practice Address - Country:US
Practice Address - Phone:248-543-8111
Practice Address - Fax:248-543-8120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070068208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
11287110OtherCAQH PROVIDER ID #
38-2482550OtherCOMMERCIAL ID #
MIG07355OtherBCN PROVIDER GROUP #
MI700F372040OtherBCBS PROVIDER GROUP #
MI10-4412899Medicaid
MIJR070068OtherSTATE LICENSE #
H54328Medicare UPIN
0M60280-004Medicare ID - Type Unspecified