MEDICARE: MICHAEL ROBIN MSW, LICSW, MPH

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	1041C0700X	Clinical Social Worker	8738	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62-57851	OTHER	MN	BHP
2	114187	OTHER	MN	UCARE MN
3	89D55RO	OTHER	MN	BCBS
4	640357300	OTHER	MN	MN CARE
5	HP30939	OTHER	MN	HEALTHPARTNERS
6	62-57851	OTHER	MN	UBH

General Provider Information

NPI Number	:	1972699080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROBIN MSW, LICSW, MPH

Provider Business Mailing Address
First Line	:	1 LUDLOW AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 W LAKE ST
Second Line	:	SUITE 210
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4527
Country	:	US
Telephone Number	:	612-925-6033
Fax Number	:	612-925-8496

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	10/05/2016

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