Healthcare Provider Details

I. General information

NPI: 1538829643
Provider Name (Legal Business Name): ROBERT DAVID LENNING RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 E 10 MILE RD
EASTPOINTE MI
48021-1256
US

IV. Provider business mailing address

21700 NORTHWESTERN HWY
SOUTHFIELD MI
48075-4906
US

V. Phone/Fax

Practice location:
  • Phone: 855-455-4554
  • Fax:
Mailing address:
  • Phone: 855-455-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number806755
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: