Provider Demographics
NPI:1144402769
Name:R STEWART ROBERTSON MD PLLC
Entity Type:Organization
Organization Name:R STEWART ROBERTSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-404-9545
Mailing Address - Street 1:755 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 231B
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4900
Mailing Address - Country:US
Mailing Address - Phone:248-404-9545
Mailing Address - Fax:248-362-6157
Practice Address - Street 1:755 W BIG BEAVER RD
Practice Address - Street 2:SUITE 231B
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4900
Practice Address - Country:US
Practice Address - Phone:248-404-9545
Practice Address - Fax:248-362-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI034679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4523539Medicaid
MIP00061983OtherMEDICARE RAILROAD
MIB44383Medicare UPIN
MI4523539Medicaid