Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 5101020106 | MI |
NPI | 1053674101 |
---|---|
Provider Name | Dr. Robert Lewis Elgin |
First Address | Saint Clair Shores, MI 48081-3203 |
Second Address | Saint Clair Shores, MI 48081-3203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 22/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0E06273 | BCBSM (01) | MI |