Individual
MR. ROBERT FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1502 WILLARD AVE # A, DETROIT LAKES, MN 56501-4324
(218) 847-3456
Mailing address
1502 WILLARD AVE, DETROIT LAKES, MN 56501-4324
(218) 847-3456
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A598473100
UMPI
MN
Enumeration date
10/22/2019
Last updated
09/30/2022
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