MEDICARE: MILTON GARY ROBERTSON 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	207VG0400X	Gynecology Physician	4301026001	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF4619	OTHER	MI	MEDICARE RR GRP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0705912	OTHER	MI	BCBSM IND. PIN
3	0G01131	OTHER	MI	BCBSM GRP PIN

General Provider Information

NPI Number	:	1841295839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILTON GARY ROBERTSON M.D.

Provider Business Mailing Address
First Line	:	1445 SHELDON RD
Second Line	:	SUITE 301
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2480
Country	:	US
Telephone Number	:	616-847-2500
Fax Number	:	616-847-6719

Provider Business Practice Location Address
First Line	:	1445 SHELDON RD
Second Line	:	SUITE 301
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2480
Country	:	US
Telephone Number	:	616-847-2500
Fax Number	:	616-847-6719

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/04/2009

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Directions to “ MILTON GARY ROBERTSON M.D.” Practice Location

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