Provider Demographics
NPI:1164445748
Name:ROBERTS, ENID ALISON (MD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:ALISON
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99251
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9251
Mailing Address - Country:US
Mailing Address - Phone:586-716-1702
Mailing Address - Fax:586-716-1706
Practice Address - Street 1:33497 23 MILE RD
Practice Address - Street 2:STE. 160
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4062
Practice Address - Country:US
Practice Address - Phone:586-716-1702
Practice Address - Fax:586-716-1706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1605015412OtherBLUE CARE NETWORK
MI371495697OtherPPOM
MI1605015412OtherBLUE CROSS BLUE SHIELD
MA1605015412OtherFEDERAL BLUE CROSS
MI4697180Medicaid
MIG35259OtherHAP
MI147471Medicaid
MI1605015412OtherMEDICAL NETWORK ONE
MI371495697OtherTRICARE
MI1605015412OtherBLUE CROSS BLUE SHIELD
MI147471Medicaid