Provider Demographics
NPI:1043662422
Name:LEPPER, ROBIN MARIE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:LEPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49252-9748
Mailing Address - Country:US
Mailing Address - Phone:517-781-0429
Mailing Address - Fax:
Practice Address - Street 1:530 W CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1873
Practice Address - Country:US
Practice Address - Phone:517-279-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302F00000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No302F00000XManaged Care OrganizationsExclusive Provider Organization