Basic Information
| Provider Information | |||||||||
| NPI: | 1063436897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCHE | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 N PERRY ST | ||||||||
| Address2: | |||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483422217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483385516 | ||||||||
| FaxNumber: | 2483385547 | ||||||||
| Practice Location | |||||||||
| Address1: | 43494 S. WOODWARD AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483381110 | ||||||||
| FaxNumber: | 2483384590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 5101007111 | MI | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.