Healthcare Provider Details

I. General information

NPI: 1427364512
Provider Name (Legal Business Name): ROBERT EDWARD CARTWRIGHT M.A.L.L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WATERFORD PKWY
SAINT JOHNS MI
48879-9630
US

IV. Provider business mailing address

1505 WATERFORD PKWY
SAINT JOHNS MI
48879-9630
US

V. Phone/Fax

Practice location:
  • Phone: 989-668-0701
  • Fax: 989-224-1424
Mailing address:
  • Phone: 989-668-0701
  • Fax: 989-224-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: