MATTHEW DAVID ROTH MSN FNP-BC NPI 1811580442

NPI Information

  • NPI: 1811580442
  • Provider Name: MATTHEW DAVID ROTH, MSN FNP-BC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 540 DOUGLASTON DR
    ORTONVILLE, MI
    ZIP 48462
  • Phone: (248) 390-7392

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NPI Details

Matthew David Roth, MSN FNP-BC is a family nurse practitioner in Ortonville, MI with 6 years of experience. Matthew David Roth, MSN FNP-BC NPI is 1811580442. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Graduation Year:2020

The provider's business location address is:

540 DOUGLASTON DR
ORTONVILLE, MI
ZIP 48462-525
Phone: (248) 390-7392

The NPI 1811580442 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/15/2021 and was last updated on 5/13/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily4704293971MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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