Provider Demographics
NPI:1669778759
Name:ROBERT HASBANY MD PLLC
Entity type:Organization
Organization Name:ROBERT HASBANY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUISNESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASBANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-547-1400
Mailing Address - Street 1:28200 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2814
Mailing Address - Country:US
Mailing Address - Phone:248-547-1400
Mailing Address - Fax:248-548-7208
Practice Address - Street 1:28200 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2814
Practice Address - Country:US
Practice Address - Phone:248-547-1400
Practice Address - Fax:248-548-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRH064166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669778759Medicaid
G41171Medicare UPIN
MI1669778759Medicaid