Organization
ST. JOHN HEALTH SYSTEM - MACOMB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD MARSHALL ROARK NURSE PRACTITIONER (ACUTE CARE NURSE PRACTITIONER)
(586) 573-5402
Entity
Organization
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5402
Mailing address
333 E MAPLEHURST ST, FERNDALE, MI 48220-1374
(248) 259-6615
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
4704229946
MI
Other
Enumeration date
10/06/2006
Last updated
08/22/2020
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