Provider Demographics
NPI:1114980893
Name:ROARTY, JOHN DENIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DENIS
Last Name:ROARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6689 ORCHARD LAKE RD #297
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-254-8140
Mailing Address - Fax:248-254-8150
Practice Address - Street 1:22731 NEWMAN
Practice Address - Street 2:SUITE 245
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-561-1777
Practice Address - Fax:313-561-8044
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053563207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2854891Medicaid
C04294Medicare UPIN
0024505002Medicare ID - Type Unspecified