Provider Demographics
NPI:1811032378
Name:ROEHRICH, HERBERT GEORGE (MD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:GEORGE
Last Name:ROEHRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HERB
Other - Middle Name:GEORGE
Other - Last Name:ROEHRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:920 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4041
Mailing Address - Country:US
Mailing Address - Phone:262-654-5333
Mailing Address - Fax:262-654-7818
Practice Address - Street 1:300 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6927
Practice Address - Country:US
Practice Address - Phone:616-455-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI291032084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
166412OtherMANAGED HEALTH NETWORK
WI31400100Medicaid
4300656OtherAETNA
WI82433OtherCHILDREN'S COMM HLTH PLAN
280209OtherVALUE OPTIONS
13772OtherUNITED BEHAVIORAL HEALTH
WI82433OtherCHILDREN'S COMM HLTH PLAN
B56112Medicare UPIN