Provider Demographics
NPI:1659419257
Name:CAROL A. ROEKLE, M.D., P.C.
Entity Type:Organization
Organization Name:CAROL A. ROEKLE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-626-4444
Mailing Address - Street 1:1736 POINT ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2273
Mailing Address - Country:US
Mailing Address - Phone:248-626-4444
Mailing Address - Fax:
Practice Address - Street 1:29994 NORTHWESTERN HWY STE H
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3225
Practice Address - Country:US
Practice Address - Phone:248-626-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030288261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4627408Medicaid
MIF06205Medicare UPIN
MI0639169Medicare PIN