Healthcare Provider Details

I. General information

NPI: 1508960253
Provider Name (Legal Business Name): ROBERT W STOKES DOPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BRETON RD SE SUITE C1
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

1815 BRETON RD SE SUITE C1
GRAND RAPIDS MI
49506
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-6030
  • Fax: 616-949-4266
Mailing address:
  • Phone: 616-949-6030
  • Fax: 616-949-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberRS007591
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: