Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301031349 | MI |
NPI | 1083793228 |
---|---|
Provider Name | Robinson M Ordona |
First Address | Royal Oak, MI 48073 |
Second Address | Royal Oak, MI 48073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2406312502 | BLUE CROSS (01) | |
A77704 | (02) |