Provider Demographics
NPI:1396873980
Name:SIAL, ROBINA IJAZ (MD)
Entity type:Individual
Prefix:MRS
First Name:ROBINA
Middle Name:IJAZ
Last Name:SIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1975 W M 21 STE 104
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8164
Mailing Address - Country:US
Mailing Address - Phone:989-729-4848
Mailing Address - Fax:989-729-4849
Practice Address - Street 1:15200 KERCHEVAL AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1356
Practice Address - Country:US
Practice Address - Phone:313-417-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396873980Medicaid