Individual
JACQUELYN R. ROBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-2436
Mailing address
HENRY FORD HEALTH SYSTEM, 3031 WEST GRAND BOULEVARD SUITE 700, DETROIT, MI 48202
(313) 916-3115
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
4301037509
MI
208000000X
Pediatrics Physician
4301037509
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134265610
—
MI
01
—
700H262280
BLUE CROSS-BLUE CROSS
—
01
—
JR037509
CHAMPUS-CHAMPUS
—
Enumeration date
11/29/2006
Last updated
03/01/2021
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