Provider Demographics
NPI:1902916570
Name:ROBERTSON, ALEXANDER - III (CSA)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:-
Last Name:ROBERTSON
Suffix:III
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44645 KERRI CT
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1573
Mailing Address - Country:US
Mailing Address - Phone:248-344-6663
Mailing Address - Fax:
Practice Address - Street 1:44645 KERRI CT
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1573
Practice Address - Country:US
Practice Address - Phone:248-344-6663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical