Provider Demographics
NPI:1710913892
Name:ROTH, FRANK (DO)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:ROTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14325 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4541
Mailing Address - Country:US
Mailing Address - Phone:734-427-9222
Mailing Address - Fax:734-427-6316
Practice Address - Street 1:14325 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4541
Practice Address - Country:US
Practice Address - Phone:734-427-9222
Practice Address - Fax:734-427-6316
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101004762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710913892Medicaid
MI2097910Medicaid
MI1710913892Medicaid
MIF36177026Medicare PIN
E31633Medicare UPIN