Individual
MATTHEW DAVID ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN FNP-BC
Contact information
Practice address
540 DOUGLASTON DR, ORTONVILLE, MI 48462-8525
(248) 390-7392
Mailing address
540 DOUGLASTON DR, ORTONVILLE, MI 48462-8525
(248) 390-7392
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704293971
MI
Other
Enumeration date
02/15/2021
Last updated
05/13/2024
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