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Organization

VILLAGE PEDIATRICS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. HERBERT J ROTH M.D (PRESIDENT)
(248) 644-5626
Entity
Organization

Contact information

Practice address
31815 SOUTHFIELD RD, SUITE 14, BEVERLY HILLS, MI 48025-5471
(248) 644-5626
(248) 644-5497
Mailing address
31815 SOUTHFIELD RD, SUITE 14, BEVERLY HILLS, MI 48025-5471
(248) 644-5626
(248) 644-5497

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1053574954
MI
05
1568452761
MI
Enumeration date
07/27/2011
Last updated
07/27/2011
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