Provider Demographics
NPI:1659300879
Name:ROCHESTER FAMILY PHYSICIANS, PC
Entity Type:Organization
Organization Name:ROCHESTER FAMILY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-651-1155
Mailing Address - Street 1:427 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1943
Mailing Address - Country:US
Mailing Address - Phone:248-651-1155
Mailing Address - Fax:248-651-8537
Practice Address - Street 1:427 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1943
Practice Address - Country:US
Practice Address - Phone:248-651-1155
Practice Address - Fax:248-651-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRD4301022346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherFEDERAL TAX ID