Healthcare Provider Details

I. General information

NPI: 1073799946
Provider Name (Legal Business Name): ROBYN SACKEYFIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE SUITE 221
GRAND RAPIDS MI
49546-3691
US

IV. Provider business mailing address

1000 E PARIS AVE SE SUITE 221
GRAND RAPIDS MI
49546-3691
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-0770
  • Fax:
Mailing address:
  • Phone: 616-222-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301108439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: