Active NPI
Michele Joann Roach
- Community Health Clinic/Center
- Detroit, MI
National Provider Identifier
1265647200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Clinic/Center
- License
- 3701-0106-0953-552
- Practice address
- 2799 W Grand Blvd
Detroit, MI 48202-2608 - Phone
- (313) 916-1231
- NPI assigned
- May 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | 3701-0106-0953-552 | MI | Primary |
Addresses
Primary practice location
2799 W Grand Blvd
Detroit, MI 48202-2608
Mailing address
18311 Cedar Island Blvd
Brownstown, MI 48174-9585
Phone (313) 995-0551
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3701-0106-0953-552 | Other | MI | CERTIFIED PHARMACY TECH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3701-0106-0953-552 | MI | MD | Community Health Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265647200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18311 CEDAR ISLAND BLVD",
"city": "BROWNSTOWN",
"state": "MI",
"postal_code": "481749585",
"telephone_number": "313-995-0551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2799 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482022608",
"telephone_number": "313-916-1231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "MICHELE",
"middle_name": "JOANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": "MI",
"license": "3701-0106-0953-552",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED PHARMACY TECH",
"identifier": "3701-0106-0953-552",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.