Provider Demographics
NPI:1992786214
Name:YOUNG, ROBBI ANNE (DPM)
Entity type:Individual
Prefix:
First Name:ROBBI
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2173
Mailing Address - Country:US
Mailing Address - Phone:616-846-3400
Mailing Address - Fax:616-846-3406
Practice Address - Street 1:600 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1947
Practice Address - Country:US
Practice Address - Phone:616-846-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002087213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4747095Medicaid
V05210Medicare UPIN
MI5852760001Medicare NSC
0P17340001Medicare ID - Type Unspecified
MI0P36250Medicare ID - Type Unspecified