Healthcare Provider Details

I. General information

NPI: 1023921517
Provider Name (Legal Business Name): ROBERT PHILIPP MANSON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2889 S 11TH ST
KALAMAZOO MI
49009-2123
US

IV. Provider business mailing address

2889 S 11TH ST
KALAMAZOO MI
49009-2123
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-1296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601001263
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: