Individual
MRS. EMILY ELIZABETH ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 OLD CENTRE RD, PORTAGE, MI 49024-4883
(269) 321-7546
(269) 321-1705
Mailing address
3000 OLD CENTRE RD, PORTAGE, MI 49024-4883
(269) 321-7546
(269) 321-1705
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005368
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770730053
—
MI
01
—
5601005368
STATE LICENSE
MI
Enumeration date
08/19/2008
Last updated
09/16/2020
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