Provider Demographics
NPI:1376556712
Name:EDWARDS, BOBBI (MD)
Entity type:Individual
Prefix:DR
First Name:BOBBI
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24901 NORTHWESTERN HWY STE 214
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2205
Mailing Address - Country:US
Mailing Address - Phone:248-483-8488
Mailing Address - Fax:248-483-8489
Practice Address - Street 1:24901 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 214
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-483-8488
Practice Address - Fax:248-483-8489
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0706339290OtherBLUE CROSS BLUE SHIELD
MI070016468OtherRAILROAD MEDICARE INDIVIDUAL
MIG80275OtherHEALTH ALLIANCE PLAN
MD264628YMPJOtherMARYLAND DC MEDICARE PIN NUMBER
MIDG7630OtherRAILROAD MEDICARE GROUP NUMBER
MI104308193Medicaid
MI0F34284OtherBCBSM
MI0N83110Medicare PIN
MIDG7630OtherRAILROAD MEDICARE GROUP NUMBER
G80275Medicare UPIN
MD264627Medicare PIN
DC264627Medicare PIN