Provider Demographics
NPI:1124054929
Name:BRITTON, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BRITTON
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 1:3215 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-9457
Mailing Address - Country:US
Mailing Address - Phone:269-683-5170
Mailing Address - Fax:
Practice Address - Street 1:3215 HOYT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-9457
Practice Address - Country:US
Practice Address - Phone:269-683-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI054094207PE0004X
IN01070687A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4725463Medicaid
MIRB054094OtherBC/BS
MI104979518Medicaid
MI4725472Medicaid
MIRB054094OtherBC/BS
MIM60660297Medicare ID - Type Unspecified
MI4725463Medicaid