MEDICARE: GINA MYISHA ROBINSON M.D.

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	208000000X	Pediatrics Physician	35072963	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000025415	OTHER	OH	UNICARE LIFE AND HEALTH
2	000000025415	OTHER	OH	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	381960	OTHER	OH	WELLCARE
5	R72963	OTHER	OH	SUMMACARE HEALTH PLAN

General Provider Information

NPI Number	:	1457352536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MYISHA ROBINSON M.D.

Provider Business Mailing Address
First Line	:	4425 ST GERMAIN BLVD
Second Line	:
City	:	WARRENSVILLE HTS
State	:	OH
Zip	:	44128
Country	:	US
Telephone Number	:	216-751-2609
Fax Number	:

Provider Business Practice Location Address
First Line	:	6559 WILSON MILLS RD
Second Line	:	BLDG D SUIE 101
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-6402
Country	:	US
Telephone Number	:	440-473-0010
Fax Number	:	440-460-2812

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/30/2011

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