Healthcare Provider Details

I. General information

NPI: 1801999271
Provider Name (Legal Business Name): ROBERT JAMES HENRY JR. AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E ELM AVE STE 111
MONROE MI
48162-2678
US

IV. Provider business mailing address

PO BOX 2085 214 E ELM AVE STE 111
MONROE MI
48161-7085
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-4080
  • Fax: 734-241-4798
Mailing address:
  • Phone: 734-241-4080
  • Fax: 734-241-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: