Individual
DR. MARK ALLAN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26715 GREENFIELD RD, SOUTHFIELD, MI 48076-4717
(216) 870-0974
Mailing address
25223 PRAIRIE DR, SOUTHFIELD, MI 48075-2076
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301109169
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0463430
—
OH
Enumeration date
09/01/2006
Last updated
02/14/2023
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