Individual
DR. DANIEL JOHN ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 BARCLAY AVE NE, SUITE 202, GRAND RAPIDS, MI 49503-2556
(616) 458-1722
(616) 458-0061
Mailing address
330 BARCLAY AVE NE, SUITE 202, GRAND RAPIDS, MI 49503-2556
(616) 458-1722
(616) 458-0061
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
DR087361
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4868466
—
MI
01
—
P00203119
RAILROAD MEDICARE
AL
Enumeration date
06/02/2006
Last updated
10/11/2007
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