Provider Demographics
NPI:1871674192
Name:IGWE, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:IGWE
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 1:1949 WEST TWELVE MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072
Mailing Address - Country:US
Mailing Address - Phone:248-543-3700
Mailing Address - Fax:248-543-4180
Practice Address - Street 1:1949 WEST TWELVE MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072
Practice Address - Country:US
Practice Address - Phone:248-543-3700
Practice Address - Fax:248-543-4180
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059771207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3496938Medicaid
MIG54285Medicare UPIN
MI3496938Medicaid