MEDICARE: MR. ROBERT JOHN MCCOMBS BA, FAODP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101YA0400X	OTHER	MI	ADDICTION PROFESSIONAL

General Provider Information

NPI Number	:	1528170891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JOHN MCCOMBS BA, FAODP

Provider Business Mailing Address
First Line	:	43293 GAINSLEY DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1848
Country	:	US
Telephone Number	:	586-254-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 N OAKLAND BLVD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1582
Country	:	US
Telephone Number	:	248-406-0090
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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