Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | DR087361 | MI |
NPI | 1578501573 |
---|---|
Provider Name | Dr. Daniel John Robertson |
First Address | Grand Rapids, MI 49503-2556 |
Second Address | Grand Rapids, MI 49503-2556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4868466 | (05) | MI |
H80609 | (02) | |
P00203119 | RAILROAD MEDICARE (01) | AL |