Healthcare Provider Details

I. General information

NPI: 1407748650
Provider Name (Legal Business Name): ROBIN RENEE YOUNGBLOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN RENEE GIBSON

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 E GRAND BLVD STE 6685
DETROIT MI
48202-3129
US

IV. Provider business mailing address

2870 E GRAND BLVD STE 6685
DETROIT MI
48202-3129
US

V. Phone/Fax

Practice location:
  • Phone: 248-900-3068
  • Fax:
Mailing address:
  • Phone: 248-900-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: