Provider Demographics
NPI:1861583759
Name:EAGLES, ROBERT L
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:EAGLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15819 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1749
Mailing Address - Country:US
Mailing Address - Phone:313-493-4900
Mailing Address - Fax:313-493-4904
Practice Address - Street 1:15819 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1749
Practice Address - Country:US
Practice Address - Phone:313-493-4900
Practice Address - Fax:313-493-4904
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4377557Medicaid
MI237464Medicare ID - Type Unspecified