Provider Demographics
NPI:1457443517
Name:PICCININI, ROBERT GG (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GG
Last Name:PICCININI
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 1:43157 SCHOENHERR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313
Mailing Address - Country:US
Mailing Address - Phone:586-997-9619
Mailing Address - Fax:586-997-9635
Practice Address - Street 1:43157 SCHOENHERR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313
Practice Address - Country:US
Practice Address - Phone:586-997-9619
Practice Address - Fax:586-997-9635
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010116302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4252042Medicaid
G76905Medicare UPIN
MI0N17290Medicare ID - Type Unspecified