Provider Demographics
NPI:1689645137
Name:DOCK, ROBERT L (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:DOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 W OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2624
Mailing Address - Country:US
Mailing Address - Phone:313-966-3300
Mailing Address - Fax:
Practice Address - Street 1:20276 MIDDLEBELT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2054
Practice Address - Country:US
Practice Address - Phone:248-476-4900
Practice Address - Fax:248-476-5435
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006350207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4143191Medicaid
MI0H24970OtherBCBS
MI0H261380OtherBCBSM
MIOM91510OtherMEDICARE PTAN
MI4387070Medicaid
MI4143191Medicaid
MIOM91510OtherMEDICARE PTAN