MEDICARE: ROBIN E.D. ILLIAN C.P.M.

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1972634723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN E.D. ILLIAN C.P.M.

Provider Business Mailing Address
First Line	:	33 EDGEWORTH AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-2411
Country	:	US
Telephone Number	:	207-233-6888
Fax Number	:	207-591-4767

Provider Business Practice Location Address
First Line	:	11 RIVER RD
Second Line	:
City	:	LIMINGTON
State	:	ME
Zip	:	04049-3709
Country	:	US
Telephone Number	:	207-233-6888
Fax Number	:	207-591-4767

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	02/27/2015

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Directions to “ ROBIN E.D. ILLIAN C.P.M.” Practice Location

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