Provider Demographics
NPI:1578555751
Name:DOANE, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:DOANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:M
Other - Last Name:DOANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:956 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1847
Mailing Address - Country:US
Mailing Address - Phone:517-787-3900
Mailing Address - Fax:517-787-4318
Practice Address - Street 1:956 COOPER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1847
Practice Address - Country:US
Practice Address - Phone:517-787-3900
Practice Address - Fax:517-787-4318
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2019-08-30
Deactivation Date:2006-04-10
Deactivation Code:
Reactivation Date:2006-04-27
Provider Licenses
StateLicense IDTaxonomies
MI4301063377207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09200000OtherPHYSICIANS HEALTH PLAN
MIP104949OtherBLUE CARE NETWORK
MI4179720001OtherMEDICARE DMERC
MI7573234OtherAETNA
MI430789310Medicaid
MI2003802132OtherBLUE CROSS BLUE SHIELD MI
MI430789310Medicaid
MI2003802132OtherBLUE CROSS BLUE SHIELD MI