Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 18190 | MI |
NPI | 1063452290 |
---|---|
Provider Name | Dr. Mark Robinson |
First Address | Ann Arbor, MI 48108-3350 |
Second Address | Ann Arbor, MI 48108-3350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |