Provider Demographics
NPI:1508081654
Name:ROBERT J. ROBINSON MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT J. ROBINSON MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-787-3276
Mailing Address - Street 1:4018 E SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3223
Mailing Address - Country:US
Mailing Address - Phone:317-787-3276
Mailing Address - Fax:317-787-3043
Practice Address - Street 1:4018 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3223
Practice Address - Country:US
Practice Address - Phone:317-787-3276
Practice Address - Fax:317-787-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023983A207Q00000X
IN01052398A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200327410Medicaid
IN200286530Medicaid
IN200327410Medicaid
IN257290Medicare PIN
IN200286530Medicaid