Provider Demographics
NPI:1629036389
Name:TRAVIS, ROBERT DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:44633 JOY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1730
Mailing Address - Country:US
Mailing Address - Phone:734-451-9692
Mailing Address - Fax:734-451-9606
Practice Address - Street 1:44633 JOY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1730
Practice Address - Country:US
Practice Address - Phone:734-451-9692
Practice Address - Fax:734-451-9606
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064261207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19790Medicare UPIN