Provider Demographics
NPI:1881782399
Name:ROBERT VARTABEDIAN M.D. P.C.
Entity type:Organization
Organization Name:ROBERT VARTABEDIAN M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VARTABEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-414-1099
Mailing Address - Street 1:990 W ANN ARBOR TRL
Mailing Address - Street 2:STE 207
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6204
Mailing Address - Country:US
Mailing Address - Phone:734-414-1099
Mailing Address - Fax:734-414-1065
Practice Address - Street 1:990 W ANN ARBOR TRL
Practice Address - Street 2:STE 207
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6204
Practice Address - Country:US
Practice Address - Phone:734-414-1099
Practice Address - Fax:734-414-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4134138Medicaid
MI4134138Medicaid