Organization
JCR DO PLC
Active
Other names
Delton Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH C. ROTH D.O. (OWNER)
(269) 623-7121
Entity
Organization
Contact information
Practice address
11275 SPRAGUE RD, DELTON, MI 49046-8493
(269) 623-7121
(269) 623-5527
Mailing address
11275 SPRAGUE RD, DELTON, MI 49046-8493
(269) 623-7121
(269) 623-5527
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101008208
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383530765
TAX ID
MI
05
—
4639104
—
MI
Enumeration date
08/31/2006
Last updated
12/15/2008
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