| Dudley Roberts M.d, L.l.c. | |
|
18245 E 10 Mile Rd Suite 120 Roseville MI 48066-5807 | |
| (586) 774-8710 | |
| (586) 774-8809 |
| Full Name | Dudley Roberts M.d, L.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 18245 E 10 Mile Rd, Roseville, Michigan |
| Authorized Official Name and Position | Dudley Roberts (OWNER) |
| Authorized Official Contact | 5867748710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dudley Roberts M.d, L.l.c. 18245 E 10 Mile Rd Suite 120 Roseville MI 48066-5807 Ph: (586) 774-8710 | Dudley Roberts M.d, L.l.c. 18245 E 10 Mile Rd Suite 120 Roseville MI 48066-5807 Ph: (586) 774-8710 |
| NPI Number | 1356377501 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 04/29/2020 |
| Medicare PECOS PAC ID | 3870532229 |
|---|---|
| Medicare Enrollment ID | O20050426000923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356377501 | NPI | - | NPPES |
| 4715716 | Medicaid | MI | |
| DR015585 | Other | MI | LICENSE |
| 1105015902 | Other | MI | BCBS |
| P00240306 | Other | MI | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | DR051585 (Michigan) | Primary |
| Provider Name | Dudley Roberts |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922094507 PECOS PAC ID: 7911979372 Enrollment ID: I20040806001272 |
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