Todd Marshall Roark NP

NPI 1972773158 - Nurse Practitioner - 363LA2100X

NPI Details
NPI 1972773158
Gender Male
Enumeration Date 03/04/2008
Last Updated 03/04/2008
Entity Type Individual
Active Over 8 years ago
Practice Location
11800 E 12 MILE RD
WARREN MI, 48093-3472, US
Phone (586) 573-5402
Fax (586) 573-5580
Business Location
FERNDALE MI, 48220-1374, US
Phone (586) 573-5402
Taxonomy Code 363LA2100X
License State Michigan
License Number 4704229946
Remove 1972773158 NPI Number

According to our database, Todd Marshall Roark NP NPI is 1972773158, taxonomy code is 363LA2100X and license number is 4704229946, license state is located at Michigan. Todd Marshall Roark NP physically located at 11800 E 12 Mile Rd, Warren MI, 48093-3472. NPI Number Todd Marshall Roark NP has the Individual type.

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1972773158 NPI number is provided on an as is basis without warranty of any kind. 1972773158 is maintained by the National Plan & Provider Enumeration System. The contents of Todd Marshall Roark NP are for informational purposes only.