Healthcare Provider Details

I. General information

NPI: 1174510796
Provider Name (Legal Business Name): GERALD F ROBBINS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 MICHIGAN AVE SUITE 101
HOLLAND MI
49423-4911
US

IV. Provider business mailing address

577 MICHIGAN AVE SUITE 101
HOLLAND MI
49423-4911
US

V. Phone/Fax

Practice location:
  • Phone: 616-393-2190
  • Fax:
Mailing address:
  • Phone: 616-393-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5101006396
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: