Individual
JACOB EDWARD ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
14555 LEVAN RD, MARION PROFESSIONAL BUILDING SUITE 311, LIVONIA, MI 48154-5083
(734) 655-2692
(734) 655-4218
Mailing address
7932 GOSHEN DR, WEST BLOOMFIELD, MI 48322-5002
(248) 417-7730
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5101015635
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010H233560
BCBSM GRP
MI
01
—
0256305894
BCBSM INDIV
MI
Enumeration date
03/28/2007
Last updated
10/01/2009
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