Healthcare Provider Details

I. General information

NPI: 1235405572
Provider Name (Legal Business Name): ROBIN'S NEST PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 DAKOTA AVE S STE 2
HURON SD
57350-2772
US

IV. Provider business mailing address

875 DAKOTA AVE S STE 2
HURON SD
57350-2772
US

V. Phone/Fax

Practice location:
  • Phone: 605-554-2300
  • Fax: 605-554-2302
Mailing address:
  • Phone: 605-554-2300
  • Fax: 605-554-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7901
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROBIN BROZ
Title or Position: PRESIDENT
Credential: DO
Phone: 605-554-2300