Healthcare Provider Details

I. General information

NPI: 1083688261
Provider Name (Legal Business Name): ROBERT N ISRAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SEYMOUR AVE
JACKSON MI
49202-3558
US

IV. Provider business mailing address

124 SEYMOUR AVE
JACKSON MI
49202-3558
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-5700
  • Fax: 517-782-3141
Mailing address:
  • Phone: 517-782-5700
  • Fax: 517-782-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRI4301052400
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: