Healthcare Provider Details

I. General information

NPI: 1578555751
Provider Name (Legal Business Name): ROBERT M DOANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT M DOANE M.D.

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date: 04/10/2006
Reactivation Date: 04/27/2006

III. Provider practice location address

956 COOPER ST
JACKSON MI
49202-1847
US

IV. Provider business mailing address

956 COOPER ST
JACKSON MI
49202-1847
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-3900
  • Fax: 517-787-4318
Mailing address:
  • Phone: 517-787-3900
  • Fax: 517-787-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301063377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: