Provider Demographics
NPI:1033257761
Name:ROBIN M MOHEREK MD PC
Entity Type:Organization
Organization Name:ROBIN M MOHEREK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOHEREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-288-3622
Mailing Address - Street 1:555 W 14 MILE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-3100
Mailing Address - Country:US
Mailing Address - Phone:248-288-3622
Mailing Address - Fax:248-288-3625
Practice Address - Street 1:555 W 14 MILE ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-3100
Practice Address - Country:US
Practice Address - Phone:248-288-3622
Practice Address - Fax:248-288-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067326207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F343640OtherBCN
MI700F343640OtherBCBS
MI700F343640OtherBCN
MI=========OtherTAX ID
G54973Medicare UPIN