Dudley Roberts M.D, L.L.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DR051585 Issued in MI

Legal business name

DUDLEY ROBERTS M.D, L.L.C.

Practice address

18245 E 10 Mile Rd
Suite 120
Roseville, MI 48066-5807

Phone

(586) 774-8710

Fax

(586) 774-8809

NPI assigned

Jun 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dudley Roberts III, M.D.NPI 1922094507

Title

Owner

Phone

(586) 774-8710

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Dudley Roberts III, M.D. Former legal business name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dudley Roberts III, M.D.

  • Internal Medicine Physician
  • Roseville, MI
  • NPI 1922094507
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1356377501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18245 E 10 MILE RD",
            "address_2": "SUITE 120",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480665807",
            "telephone_number": "586-774-8710",
            "fax_number": "586-774-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18245 E 10 MILE RD",
            "address_2": "SUITE 120",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480665807",
            "telephone_number": "586-774-8710",
            "fax_number": "586-774-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUDLEY ROBERTS M.D, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "DUDLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-774-8710",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "DR051585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4715716",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "DR015585",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1105015902",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00240306",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dudley Roberts III, M.D.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Dudley Roberts III, M.D.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Internal Medicine Physician in Roseville, MI
• Providers in Roseville, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.