Provider Demographics
NPI:1386724771
Name:ROBERT G MOBLEY MD PC
Entity type:Organization
Organization Name:ROBERT G MOBLEY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-263-1168
Mailing Address - Street 1:42524 HAYES RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6764
Mailing Address - Country:US
Mailing Address - Phone:586-263-1168
Mailing Address - Fax:586-263-1169
Practice Address - Street 1:42524 HAYES RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6764
Practice Address - Country:US
Practice Address - Phone:586-263-1168
Practice Address - Fax:586-263-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P00370Medicare PIN