Provider Demographics
NPI:1013958073
Name:ROBERT DANIEL TRAVIS, M.D., PC
Entity Type:Organization
Organization Name:ROBERT DANIEL TRAVIS, M.D., PC
Other - Org Name:ADVANCED ORTHOPAEDIC SURGEONS OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-451-9692
Mailing Address - Street 1:44633 JOY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1732
Mailing Address - Country:US
Mailing Address - Phone:734-451-9692
Mailing Address - Fax:734-451-9606
Practice Address - Street 1:44633 JOY RD STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1732
Practice Address - Country:US
Practice Address - Phone:734-451-9692
Practice Address - Fax:734-451-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRT064261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG01030Medicare UPIN