Provider Demographics
NPI:1538232954
Name:MIELKE, ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MIELKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 STAR BATT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3709
Mailing Address - Country:US
Mailing Address - Phone:248-289-6817
Mailing Address - Fax:248-289-1141
Practice Address - Street 1:1880 STAR BATT DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3709
Practice Address - Country:US
Practice Address - Phone:248-289-6817
Practice Address - Fax:248-289-1141
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION16820Medicare ID - Type UnspecifiedPROFESSIONAL PROVIDER
MIMI3150001Medicare PIN