Healthcare Provider Details

I. General information

NPI: 1750559415
Provider Name (Legal Business Name): ROBERT M DOANE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 LAURENCE AVE
JACKSON MI
49202-2966
US

IV. Provider business mailing address

PO BOX 807
JACKSON MI
49204-0807
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-3900
  • Fax: 517-787-0730
Mailing address:
  • Phone: 517-787-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number63377
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT M DOANE
Title or Position: OWNER
Credential: MD
Phone: 517-787-3900