Provider Demographics
NPI:1356349807
Name:SONDRA ROBIN
Entity type:Organization
Organization Name:SONDRA ROBIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-753-5864
Mailing Address - Street 1:13498 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2430
Mailing Address - Country:US
Mailing Address - Phone:734-281-1968
Mailing Address - Fax:734-281-1968
Practice Address - Street 1:13498 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2430
Practice Address - Country:US
Practice Address - Phone:734-281-1968
Practice Address - Fax:734-281-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI024539Medicaid
MI540H221370OtherBLUE CROSS/BLUE SHIELD MI
TX=========OtherAETNA
WI=========OtherFISERV HEALTH
NY=========OtherUNITED HEALTH CARE
MI024539Medicaid
TX=========OtherAETNA