Provider Demographics
NPI:1902849946
Name:LEFEVRE, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:LEFEVRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-170A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-338-1506
Mailing Address - Fax:269-381-1655
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-170
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-5060
Practice Address - Fax:269-381-1655
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1103906941OtherBCBS IND PIN
MI3489227-10Medicaid
155412OtherGREAT LAKES HLTH PLN
MI1902849946Medicaid
MI110C910470OtherBCBS GRP PIN
5784251OtherAETNA PIN
MI1103906941OtherBCBS IND PIN
155412OtherGREAT LAKES HLTH PLN
MI3489227-10Medicaid
MICI6212Medicare PIN
MI110180819Medicare PIN