Provider Demographics
NPI:1841295839
Name:ROBERTSON, MILTON GARY (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:GARY
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 SHELDON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2480
Mailing Address - Country:US
Mailing Address - Phone:616-847-2500
Mailing Address - Fax:616-847-6719
Practice Address - Street 1:1445 SHELDON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2480
Practice Address - Country:US
Practice Address - Phone:616-847-2500
Practice Address - Fax:616-847-6719
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301026001207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0705912OtherBCBSM IND. PIN
MIDF4619OtherMEDICARE RR GRP PIN
MI0G01131OtherBCBSM GRP PIN
MI0705912OtherBCBSM IND. PIN
MIDF4619OtherMEDICARE RR GRP PIN