Provider Demographics
NPI:1073513420
Name:THILL, ROBERT DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:THILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 BAY RD
Mailing Address - Street 2:SUITE 1S
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2417
Mailing Address - Country:US
Mailing Address - Phone:989-793-9983
Mailing Address - Fax:989-793-9951
Practice Address - Street 1:3875 BAY RD
Practice Address - Street 2:SUITE 1S
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2417
Practice Address - Country:US
Practice Address - Phone:989-793-9983
Practice Address - Fax:989-793-9951
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRT070198208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MART070198OtherLICENSE
G54832Medicare UPIN