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NPI Code Detail

MEDICARE: DR. LARRY J ROBSON M.D.

MEDICARE: DR. LARRY J ROBSON 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
12086S0129XVascular Surgery Physician4301025828MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2770002740OTHERMIRAILROAD MEDICARE

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 : 1689665002
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY J ROBSON M.D.
Provider Business Mailing Address
First Line : PO BOX 152057
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49515-2057
Country : US
Telephone Number : 616-885-5000
Fax Number : 616-913-9025
Provider Business Practice Location Address
First Line : 2900 BRADFORD ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-6427
Country : US
Telephone Number : 616-885-5000
Fax Number : 616-913-9025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 11/05/2010

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