Provider Demographics
NPI:1053751511
Name:ROESCH, MICHAEL CLARK (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLARK
Last Name:ROESCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 5320
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3937
Mailing Address - Country:US
Mailing Address - Phone:614-566-1997
Mailing Address - Fax:
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 5320
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-566-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126403207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine