Provider Demographics
NPI:1992732895
Name:ROTH, HERBERT J JR (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:J
Last Name:ROTH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 W BIG BEAVER RD
Mailing Address - Street 2:STE 1060
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-457-9190
Mailing Address - Fax:248-457-9188
Practice Address - Street 1:201 W BIG BEAVER RD
Practice Address - Street 2:STE 1060
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-457-9190
Practice Address - Fax:248-457-9188
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407009207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M32860Medicare ID - Type Unspecified
F31058Medicare UPIN