Provider Demographics
NPI:1659862217
Name:CONWAY, ROBERT M (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3260
Mailing Address - Country:US
Mailing Address - Phone:248-865-4444
Mailing Address - Fax:
Practice Address - Street 1:30055 NORTHWESTERN HWY STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3260
Practice Address - Country:US
Practice Address - Phone:248-865-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025593207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty