Provider Demographics
NPI:1457524456
Name:FRANK ROTH DO PC
Entity Type:Organization
Organization Name:FRANK ROTH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-474-2400
Mailing Address - Street 1:19223 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1754
Mailing Address - Country:US
Mailing Address - Phone:248-474-2400
Mailing Address - Fax:248-474-4730
Practice Address - Street 1:19223 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1754
Practice Address - Country:US
Practice Address - Phone:248-474-2400
Practice Address - Fax:248-474-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101004762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0858214954OtherBLUE CROSS BLUE SHIELD
MI2097910Medicaid
MI0858214954OtherBLUE CROSS BLUE SHIELD
MI2097910Medicaid