Provider Demographics
NPI:1083677439
Name:AUSTIN, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:AUSTIN
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 1:1428 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-6320
Mailing Address - Country:US
Mailing Address - Phone:269-873-8955
Mailing Address - Fax:269-324-2476
Practice Address - Street 1:615 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1033
Practice Address - Country:US
Practice Address - Phone:574-647-1650
Practice Address - Fax:574-647-1655
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20122207VM0101X
IN01053969A207VM0101X
MI4301033245207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4656419Medicaid
MI6062403Medicaid
MI1604114351OtherBCBS
MI1558407189OtherGROUP NPI
MI1604114351OtherBCBS
MI4656419Medicaid
MIC97618143Medicare PIN