Healthcare Provider Details

I. General information

NPI: 1689645137
Provider Name (Legal Business Name): ROBERT L DOCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20276 MIDDLEBELT RD SUITE 2
LIVONIA MI
48152-2054
US

IV. Provider business mailing address

6071 W OUTER DR
DETROIT MI
48235-2624
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-4900
  • Fax: 248-476-5435
Mailing address:
  • Phone: 313-966-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101006350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: