Active NPI
Michael Roth, MD
- Ophthalmology Physician
- Ann Arbor, MI
National Provider Identifier
1568654044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 4301034106
- Practice address
- 1060 Chestnut St
Ann Arbor, MI 48104-2824 - Phone
- (734) 975-0001
- NPI assigned
- Aug 17, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 4301034106 | MI | Primary |
Addresses
Primary practice location
1060 Chestnut St
Ann Arbor, MI 48104-2824
Mailing address
1060 Chestnut St
Ann Arbor, MI 48104-2824
Phone (734) 975-0001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4301034106 | Other | MI | MEDICAL LICENSE |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301034106 | MI | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187308800000",
"number": "1568654044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1060 CHESTNUT ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481042824",
"telephone_number": "734-975-0001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 CHESTNUT ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481042824",
"telephone_number": "734-975-0001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-17",
"last_updated": "2007-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MI",
"license": "4301034106",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "4301034106",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.