Provider Demographics
NPI:1992711105
Name:LAURETTE C. ROBEY, MD PC
Entity type:Organization
Organization Name:LAURETTE C. ROBEY, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-497-8677
Mailing Address - Street 1:2001 N GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-2110
Mailing Address - Country:US
Mailing Address - Phone:765-284-0493
Mailing Address - Fax:765-284-2434
Practice Address - Street 1:10343 DAWSONS CREEK BLVD
Practice Address - Street 2:#6C
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1906
Practice Address - Country:US
Practice Address - Phone:260-497-8677
Practice Address - Fax:260-197-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN138540Medicare PIN
A01900Medicare UPIN