| Edward Roberts Pllc | |
|
15000 Gratiot Ave Detroit MI 48205-1973 | |
| (313) 307-4967 | |
| Not Available |
| Full Name | Edward Roberts Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 15000 Gratiot Ave, Detroit, Michigan |
| Authorized Official Name and Position | Edward Roberts (OWNER) |
| Authorized Official Contact | 3133074967 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward Roberts Pllc 25146 Lindenwood Ln Southfield MI 48033-6103 Ph: (248) 497-1399 | Edward Roberts Pllc 15000 Gratiot Ave Detroit MI 48205-1973 Ph: (313) 307-4967 |
| NPI Number | 1992348197 |
|---|---|
| Provider Enumeration Date | 10/21/2019 |
| Last Update Date | 10/21/2019 |
| Medicare PECOS PAC ID | 2769816990 |
|---|---|
| Medicare Enrollment ID | O20191123000164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992348197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Edward Roberts |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871611251 PECOS PAC ID: 4385603943 Enrollment ID: I20041008000173 |
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