Provider Demographics
NPI:1770536989
Name:ROBY, MARK (PAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ROBY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1245 DERBY RD
Mailing Address - Street 2:#7
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5809
Mailing Address - Country:US
Mailing Address - Phone:248-318-8775
Mailing Address - Fax:
Practice Address - Street 1:30840 NORTHWESTERN HWY
Practice Address - Street 2:STE 110
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2552
Practice Address - Country:US
Practice Address - Phone:248-626-7544
Practice Address - Fax:248-626-9698
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIMR001689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant