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Organization
VILLAGE PEDIATRICS PLLC
Active
Organization
VILLAGE PEDIATRICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERBERT J ROTH M.D (PRESIDENT)
(248) 644-5626
Entity
Organization
Contact information
Practice address
31815 SOUTHFIELD RD, SUITE 14, BEVERLY HILLS, MI 48025-5471
(248) 644-5626
(248) 644-5497
Mailing address
31815 SOUTHFIELD RD, SUITE 14, BEVERLY HILLS, MI 48025-5471
(248) 644-5626
(248) 644-5497
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053574954
—
MI
05
—
1568452761
—
MI
Enumeration date
07/27/2011
Last updated
07/27/2011
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