Healthcare Provider Details

I. General information

NPI: 1841295839
Provider Name (Legal Business Name): MILTON GARY ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 SHELDON RD SUITE 301
GRAND HAVEN MI
49417-2480
US

IV. Provider business mailing address

1445 SHELDON RD SUITE 301
GRAND HAVEN MI
49417-2480
US

V. Phone/Fax

Practice location:
  • Phone: 616-847-2500
  • Fax: 616-847-6719
Mailing address:
  • Phone: 616-847-2500
  • Fax: 616-847-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4301026001
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: