Healthcare Provider Details

I. General information

NPI: 1881705564
Provider Name (Legal Business Name): MICHAEL D ROBBINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N CHAMBER DR
FREDERICKTOWN MO
63645-7947
US

IV. Provider business mailing address

355 N CHAMBER DR
FREDERICKTOWN MO
63645-7947
US

V. Phone/Fax

Practice location:
  • Phone: 573-944-7231
  • Fax: 573-561-1166
Mailing address:
  • Phone: 573-944-7231
  • Fax: 573-561-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036105498
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001019992
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: