Healthcare Provider Details

I. General information

NPI: 1104467760
Provider Name (Legal Business Name): MICHAEL ROBINSON ND, MS, CNS, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117B MAIN ST STE 3
DOWNERS GROVE IL
60515-4602
US

IV. Provider business mailing address

218 PLYMOUTH LN
BOLINGBROOK IL
60440-1923
US

V. Phone/Fax

Practice location:
  • Phone: 630-432-0169
  • Fax:
Mailing address:
  • Phone: 708-699-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0134102
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number164.007859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: