Healthcare Provider Details

I. General information

NPI: 1568903474
Provider Name (Legal Business Name): MS. CAROL H. ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STODDARD RD
RICHMOND MI
48062-2505
US

IV. Provider business mailing address

42200 ASPEN CT
CLINTON TOWNSHIP MI
48038-5261
US

V. Phone/Fax

Practice location:
  • Phone: 810-392-2167
  • Fax: 810-392-2135
Mailing address:
  • Phone: 586-924-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: