Healthcare Provider Details

I. General information

NPI: 1871809798
Provider Name (Legal Business Name): ROBERT JEFFREY ERNST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MARTIN ST SUITE 210
BIRMINGHAM MI
48009-1486
US

IV. Provider business mailing address

320 MARTIN ST SUITE 210
BIRMINGHAM MI
48009-1486
US

V. Phone/Fax

Practice location:
  • Phone: 248-737-8600
  • Fax: 248-737-8601
Mailing address:
  • Phone: 248-737-8600
  • Fax: 248-737-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4301060985
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: