Healthcare Provider Details

I. General information

NPI: 1932198488
Provider Name (Legal Business Name): ROBERT W CLAUSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N EDDY ST
SOUTH BEND IN
46617-2808
US

IV. Provider business mailing address

211 N EDDY ST
SOUTH BEND IN
46617-2808
US

V. Phone/Fax

Practice location:
  • Phone: 574-237-9217
  • Fax: 574-239-1451
Mailing address:
  • Phone: 574-237-9217
  • Fax: 574-239-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number01031859A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: