Provider Demographics
NPI:1629098579
Name:ROBINSON, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:ROBINSON
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 1:10110 DONALD S POWERS DRIVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-513-2100
Mailing Address - Fax:219-836-2100
Practice Address - Street 1:10110 DONALD S POWERS DRIVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-513-2100
Practice Address - Fax:219-836-2100
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053821A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN180060Medicare ID - Type Unspecified
INH36059Medicare UPIN