Individual
ANTHONY ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1401 W NORTH ST, JACKSON, MI 49202-3135
(517) 205-2555
(517) 205-0117
Mailing address
1401 W NORTH ST, JACKSON, MI 49202-3135
(517) 205-2555
(517) 205-0117
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008569
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
02/05/2018
Last updated
02/02/2021
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