Provider Demographics
NPI:1366146995
Name:ROBISON, MICHAEL DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:ROBISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY AT STONY BROOK DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - Street 2:HEALTH SERVICES CENTER LEVEL 4, ROOM 050
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8350
Mailing Address - Country:US
Mailing Address - Phone:631-444-3880
Mailing Address - Fax:
Practice Address - Street 1:SUNY AT STONY BROOK DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - Street 2:HEALTH SERVICES CENTER LEVEL 4, ROOM 050
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8350
Practice Address - Country:US
Practice Address - Phone:631-444-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program