Provider Demographics
NPI:1790792273
Name:ROOPAS, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:ROOPAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CEDAR WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9793
Mailing Address - Country:US
Mailing Address - Phone:770-845-2730
Mailing Address - Fax:
Practice Address - Street 1:2000 VILLAGE PROFESSIONAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8494
Practice Address - Country:US
Practice Address - Phone:678-324-1306
Practice Address - Fax:770-635-8806
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014042832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3005100322OtherBCBSM INDIVIDUAL PIN
MI4799171Medicaid
MIM23560164Medicare PIN
MIM65080049Medicare PIN
MI3005100322OtherBCBSM INDIVIDUAL PIN
MIE61935Medicare UPIN