Provider Demographics
NPI:1184660300
Name:CLEARY, ROBERT K (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:CLEARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5325 ELLIOTT DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8633
Mailing Address - Country:US
Mailing Address - Phone:734-712-8150
Mailing Address - Fax:734-712-8151
Practice Address - Street 1:5325 ELLIOTT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-8150
Practice Address - Fax:734-712-8151
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301404804208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI414714510Medicaid
0M88760009Medicare ID - Type Unspecified
MI414714510Medicaid