Provider Demographics
NPI:1326114927
Name:ORR, ROBERT C (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:ORR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22821 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3230
Mailing Address - Country:US
Mailing Address - Phone:248-615-6600
Mailing Address - Fax:248-615-6605
Practice Address - Street 1:22821 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3230
Practice Address - Country:US
Practice Address - Phone:248-615-6600
Practice Address - Fax:248-615-6605
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005472208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010H261900OtherBCBSM
MI236661OtherMEDICARE PROVIDER NO
MI340H210660OtherBCN
MI112708OtherGREAT LAKES HEALTH PLAN
MI113098064Medicaid
MI236661OtherMEDICARE PROVIDER NO
MIMI10143015-MI10143Medicare PIN
MI112708OtherGREAT LAKES HEALTH PLAN