Provider Demographics
NPI:1992761514
Name:YAGOOBIAN, ROBERT A (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:YAGOOBIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3832
Mailing Address - Country:US
Mailing Address - Phone:313-292-8400
Mailing Address - Fax:313-292-8430
Practice Address - Street 1:9224 PELHAM RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3832
Practice Address - Country:US
Practice Address - Phone:313-292-8400
Practice Address - Fax:313-292-8430
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRY000639213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT34386Medicare UPIN