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Organization

COMMERCE PSYCHIATRIC SERVICES PLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRUCE LELAND ROTH (OWNER)
(248) 360-6102
Entity
Organization

Contact information

Practice address
55 NORTH POND DRIVE, SUITE 6, WALLED LAKE, MI 48390
(248) 669-1900
(248) 669-1925
Mailing address
55 NORTH POND DRIVE, SUITE 6, WALLED LAKE, MI 48390
(248) 669-1900
(248) 669-1925

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MI
2084P0804X
Child & Adolescent Psychiatry Physician
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2656300704
BCBS MI
Enumeration date
10/25/2006
Last updated
07/19/2007
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