Provider Demographics
NPI:1801829429
Name:MIKA, ROBIN (DO)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MIKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 GRAND RIVER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6533
Mailing Address - Country:US
Mailing Address - Phone:810-227-1020
Mailing Address - Fax:810-227-4930
Practice Address - Street 1:10415 GRAND RIVER RD
Practice Address - Street 2:STE 100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6533
Practice Address - Country:US
Practice Address - Phone:810-227-1020
Practice Address - Fax:810-227-4930
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM007113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1363440Medicaid
MIE 26635Medicare UPIN
MI1363440Medicaid