Provider Demographics
NPI:1548245095
Name:HALTER, ROBERT L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HALTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 298
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:2147 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-0003
Practice Address - Country:US
Practice Address - Phone:989-732-1753
Practice Address - Fax:989-731-1425
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2013-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI006632207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356544Medicaid
MI0F96004OtherGROUP MEDICARE ID NUMBER
MIC20677OtherRAILROAD MEDICARE
MIE31605Medicare UPIN
MI1356544Medicaid