Healthcare Provider Details

I. General information

NPI: 1275864464
Provider Name (Legal Business Name): ROBIN EDWARD FERINGA RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76181 33RD ST
LAWTON MI
49065-9343
US

IV. Provider business mailing address

76181 33RD ST
LAWTON MI
49065-9343
US

V. Phone/Fax

Practice location:
  • Phone: 269-624-3102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: