Healthcare Provider Details

I. General information

NPI: 1871674192
Provider Name (Legal Business Name): ROBERT IGWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 WEST TWELVE MILE RD STE 200
BERKLEY MI
48072
US

IV. Provider business mailing address

1949 WEST TWELVE MILE RD STE 200
BERKLEY MI
48072
US

V. Phone/Fax

Practice location:
  • Phone: 248-543-3700
  • Fax: 248-543-4180
Mailing address:
  • Phone: 248-543-3700
  • Fax: 248-543-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301059771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: