Provider Demographics
NPI:1104467760
Name:ROBINSON, MICHAEL (ND, MS, CNS, LDN)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:ND, MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 PLYMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1923
Mailing Address - Country:US
Mailing Address - Phone:708-699-3330
Mailing Address - Fax:
Practice Address - Street 1:5117B MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4602
Practice Address - Country:US
Practice Address - Phone:630-432-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0134102175F00000X
IL164.007859133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No175F00000XOther Service ProvidersNaturopath