Provider Demographics
NPI:1477569408
Name:CLELAND, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:CLELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3409 LUDINGTON ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4213
Mailing Address - Country:US
Mailing Address - Phone:906-786-2800
Mailing Address - Fax:906-786-5562
Practice Address - Street 1:3409 LUDINGTON ST STE 206
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-4213
Practice Address - Country:US
Practice Address - Phone:906-786-2800
Practice Address - Fax:906-786-5562
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055598208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2628200Medicaid
MI2628200Medicaid
MI0210013Medicare ID - Type Unspecified