Provider Demographics
NPI:1336407485
Name:CRAIN, ROBERT L (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:CRAIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2310
Mailing Address - Country:US
Mailing Address - Phone:917-535-4242
Mailing Address - Fax:
Practice Address - Street 1:100 W BIG BEAVER RD
Practice Address - Street 2:SUITE 655
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5206
Practice Address - Country:US
Practice Address - Phone:248-528-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist