Provider Demographics
NPI:1508827049
Name:ROBERTS, KARL C (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:C
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 E PARIS AVE SE STE 240
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6117
Mailing Address - Country:US
Mailing Address - Phone:616-949-8945
Mailing Address - Fax:616-949-1115
Practice Address - Street 1:2144 E PARIS AVE SE STE 240
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6117
Practice Address - Country:US
Practice Address - Phone:616-949-8945
Practice Address - Fax:616-949-1115
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072367207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4514905Medicaid
MIP00046296Medicare PIN
MIH87232Medicare UPIN
MI4514905Medicaid
MI0P50540001Medicare PIN