Healthcare Provider Details

I. General information

NPI: 1477762367
Provider Name (Legal Business Name): SEAN A ROBINSON LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 EASTERN AVE SE
GRAND RAPIDS MI
49507-3632
US

IV. Provider business mailing address

2400 EASTERN AVE SE
GRAND RAPIDS MI
49507-3632
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-3433
  • Fax: 313-899-7087
Mailing address:
  • Phone: 616-988-3433
  • Fax: 616-233-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401009578
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: