MEDICARE: DR. ROBERT B FERGUSON M.D., P.C

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
1	207RG0100X	Gastroenterology Physician	4301058431	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	124607	OTHER	MI	GREAT LAKES HEALTH PLAN

General Provider Information

NPI Number	:	1174694673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT B FERGUSON M.D., P.C

Provider Business Mailing Address
First Line	:	758 WOODCHESTER
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48304
Country	:	US
Telephone Number	:	248-408-2170
Fax Number	:	248-723-5874

Provider Business Practice Location Address
First Line	:	4256 ORCHARD LAKE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-1645
Country	:	US
Telephone Number	:	248-682-1720
Fax Number	:	248-682-9289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ROBERT B FERGUSON M.D., P.C” Practice Location

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