Provider Demographics
NPI:1467566091
Name:ROCHESTER HILLS HEALTH SERVICES P.L.L.C.
Entity Type:Organization
Organization Name:ROCHESTER HILLS HEALTH SERVICES P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CERVONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-852-9290
Mailing Address - Street 1:2840 CROOKS RD
Mailing Address - Street 2:100
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3619
Mailing Address - Country:US
Mailing Address - Phone:248-852-9290
Mailing Address - Fax:248-852-0305
Practice Address - Street 1:2840 CROOKS RD
Practice Address - Street 2:100
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3619
Practice Address - Country:US
Practice Address - Phone:248-852-9290
Practice Address - Fax:248-852-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P35940Medicare ID - Type Unspecified
MIH75669Medicare UPIN