Healthcare Provider Details

I. General information

NPI: 1780645705
Provider Name (Legal Business Name): ROBERT R OGAR ACT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39885 GRAND RIVER STE 300
NOVI MI
48375
US

IV. Provider business mailing address

39885 GRAND RIVER STE 300
NOVI MI
48375
US

V. Phone/Fax

Practice location:
  • Phone: 248-615-0282
  • Fax: 248-615-0415
Mailing address:
  • Phone: 248-615-0282
  • Fax: 248-615-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: