Provider Demographics
NPI:1184738783
Name:NORRIS, ROBERT E (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:NORRIS
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 1:804 SERVICE RD
Mailing Address - Street 2:# A109F
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:SUITE 420
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-884-6100
Practice Address - Fax:517-884-6233
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070997207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4432819Medicaid
MI1184738783Medicaid
MIH43260Medicare UPIN
MI0C36088068Medicare ID - Type Unspecified
MI4432819Medicaid
MI0C36019087Medicare PIN