Basic Information
| Provider Information | |||||||||
| NPI: | 1467566091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCHESTER HILLS HEALTH SERVICES P.L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2840 CROOKS RD | ||||||||
| Address2: | 100 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483093619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488529290 | ||||||||
| FaxNumber: | 2488520305 | ||||||||
| Practice Location | |||||||||
| Address1: | 2840 CROOKS RD | ||||||||
| Address2: | 100 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483093619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488529290 | ||||||||
| FaxNumber: | 2488520305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CERVONE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2488529290 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101014745 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.