Healthcare Provider Details

I. General information

NPI: 1235277831
Provider Name (Legal Business Name): ROBERT DENNIS ALLERS LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5181 PLAINFIELD AVE NE SUITE C
GRAND RAPIDS MI
49525-1086
US

IV. Provider business mailing address

13499 STACEY RD NE
GREENVILLE MI
48838-9005
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-3365
  • Fax: 616-361-3395
Mailing address:
  • Phone: 616-361-3365
  • Fax: 616-361-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301003194
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: