Provider Demographics
NPI:1417552647
Name:ROBINSON, DWYANE J
Entity Type:Individual
Prefix:
First Name:DWYANE
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18221 FLORAL ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3717
Mailing Address - Country:US
Mailing Address - Phone:313-878-5374
Mailing Address - Fax:
Practice Address - Street 1:18221 FLORAL ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3717
Practice Address - Country:US
Practice Address - Phone:313-878-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver