Provider Demographics
NPI:1427158856
Name:ROBINS, E LANNY (MD)
Entity type:Individual
Prefix:
First Name:E
Middle Name:LANNY
Last Name:ROBINS
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 1:4401 YELLOW BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-8410
Mailing Address - Country:US
Mailing Address - Phone:715-470-2710
Mailing Address - Fax:
Practice Address - Street 1:4401 YELLOW BIRCH RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-8410
Practice Address - Country:US
Practice Address - Phone:715-479-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21203207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30429300Medicaid
B56096Medicare UPIN
WI007351025Medicare ID - Type Unspecified