Healthcare Provider Details

I. General information

NPI: 1861563512
Provider Name (Legal Business Name): ROBERT KERRY SHLAIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7432 SHERWOOD CREEK COURT
WEST BLOOMFIELD MI
48322-3170
US

IV. Provider business mailing address

7432 SHERWOOD CREEK COURT
WEST BLOOMFIELD MI
48322-3170
US

V. Phone/Fax

Practice location:
  • Phone: 248-788-1099
  • Fax:
Mailing address:
  • Phone: 248-788-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0927
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2537
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1314
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: