Provider Demographics
NPI:1932333903
Name:CRAIG W ROODBEEN PC
Entity Type:Organization
Organization Name:CRAIG W ROODBEEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROODBEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-244-9426
Mailing Address - Street 1:1350 KIRTS BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4851
Mailing Address - Country:US
Mailing Address - Phone:248-244-9426
Mailing Address - Fax:248-244-9495
Practice Address - Street 1:1350 KIRTS BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4851
Practice Address - Country:US
Practice Address - Phone:248-244-9426
Practice Address - Fax:248-244-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055804207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5913970001Medicare NSC