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General NPI Number Information
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NPI Number | 1700837648
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Entity Type | Individual
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Provider Name | ROBERT GEORGE FAWCETT M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2206 MITCHELL PARK DR STE 10
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City | PETOSKEY
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State | MI
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Zip | 49770-8674
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Country | US
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Telephone | 231-487-2415
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Fax | 231-487-6569
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Provider Business Mailing Address
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Address Line | 2206 MITCHELL PARK DR STE 10
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City | PETOSKEY
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State | MI
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Zip | 49770-8674
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Country | US
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Telephone | 231-487-2415
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Fax | 231-487-6569
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301038067
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License Number State | MI
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