Provider Demographics
NPI:1861642167
Name:AUTH, ROBERT H (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:AUTH
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 1:9820 INGRAM ST.
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2818
Mailing Address - Country:US
Mailing Address - Phone:734-261-5924
Mailing Address - Fax:734-261-5924
Practice Address - Street 1:9820 INGRAM ST.
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2818
Practice Address - Country:US
Practice Address - Phone:734-261-5924
Practice Address - Fax:734-261-5924
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010048702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1835686Medicaid
MI1835686Medicaid