Provider Demographics
NPI: | 1760539597 |
---|---|
Name: | PELEMAN, ROBERT R (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ROBERT |
Middle Name: | R |
Last Name: | PELEMAN |
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: | 15855 19 MILE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CLINTON TWP |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48038-3504 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 586-263-2373 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 15855 19 MILE RD |
Practice Address - Street 2: | |
Practice Address - City: | CLINTON TWP |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48038-3504 |
Practice Address - Country: | US |
Practice Address - Phone: | 586-263-2373 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-04 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301405347 | 207L00000X, 208VP0014X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
Not Answered | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 0505028011 | Other | BCBS |
MI | 0N47420 | Medicare ID - Type Unspecified | |
MI | B46811 | Medicare UPIN |