Healthcare Provider Details

I. General information

NPI: 1972590420
Provider Name (Legal Business Name): J ALAN ROBERTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 E 10 MILE RD SUITE 130
EASTPOINTE MI
48021-3349
US

IV. Provider business mailing address

17200 E 10 MILE RD SUITE 130
EASTPOINTE MI
48021-3349
US

V. Phone/Fax

Practice location:
  • Phone: 586-585-9047
  • Fax: 586-585-9126
Mailing address:
  • Phone: 586-585-9047
  • Fax: 586-585-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301049006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: