Provider Demographics
NPI:1942922984
Name:ROBIN SAMYN, MD PLLC
Entity Type:Organization
Organization Name:ROBIN SAMYN, MD PLLC
Other - Org Name:ROBIN SAMYN, MD, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-549-6884
Mailing Address - Street 1:18411 WIGEON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1174
Mailing Address - Country:US
Mailing Address - Phone:586-549-6884
Mailing Address - Fax:
Practice Address - Street 1:25350 KELLY RD STE B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5824
Practice Address - Country:US
Practice Address - Phone:586-944-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty