Provider Demographics
NPI:1891027173
Name:ROEDER, RUTH ALMA
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ALMA
Last Name:ROEDER
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE UHC 6F MAILBOX# 226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-6618
Practice Address - Street 1:3901 BEAUBIEN 3RD FLOOR MAIN BLDG
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5906
Practice Address - Fax:313-745-0955
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704128683363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care