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NPI Code Detail

MEDICARE: ROBERT P ROBERTS JR. MD

MEDICARE: ROBERT P ROBERTS JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician4301043739MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093823528
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT P ROBERTS JR. MD
Provider Business Mailing Address
First Line : 781 KENMOOR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8624
Country : US
Telephone Number : 616-726-1300
Fax Number : 616-726-1302
Provider Business Practice Location Address
First Line : 781 KENMOOR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8624
Country : US
Telephone Number : 616-726-1300
Fax Number : 616-726-1302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 12/19/2012

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