Healthcare Provider Details

I. General information

NPI: 1477754620
Provider Name (Legal Business Name): ROBERT PENSLER M D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

31160 HUNTERS DR
FARMINGTON HILLS MI
48334-1214
US

V. Phone/Fax

Practice location:
  • Phone: 248-932-2607
  • Fax:
Mailing address:
  • Phone: 248-932-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberRP077774
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberRP077774
License Number StateMI

VIII. Authorized Official

Name: ROBERT PENSLER
Title or Position: PRESIDENT
Credential: MD
Phone: 248-932-2607