Provider Demographics
NPI:1861661985
Name:ENID ROBERTS MD PLLC
Entity Type:Organization
Organization Name:ENID ROBERTS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-716-1702
Mailing Address - Street 1:PO BOX 99251
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9251
Mailing Address - Country:US
Mailing Address - Phone:586-716-1702
Mailing Address - Fax:586-716-1706
Practice Address - Street 1:33497 23 MILE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4062
Practice Address - Country:US
Practice Address - Phone:586-716-1702
Practice Address - Fax:586-716-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P12150001Medicare PIN