Provider Demographics
NPI:1760404214
Name:CROMPTON, ROBERT MACNAIR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MACNAIR
Last Name:CROMPTON
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 1:300 S RATH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-3003
Mailing Address - Country:US
Mailing Address - Phone:231-845-8093
Mailing Address - Fax:231-845-8061
Practice Address - Street 1:300 S RATH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-3003
Practice Address - Country:US
Practice Address - Phone:231-845-8093
Practice Address - Fax:231-845-8061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0805300102OtherBCBS
MI2757557Medicaid
MIE87900Medicare UPIN
MI05300108082Medicare ID - Type Unspecified