Provider Demographics
NPI:1669714242
Name:HAN, ROBERT MAOSHING (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MAOSHING
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:818 W KING ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2159
Mailing Address - Country:US
Mailing Address - Phone:989-725-8171
Mailing Address - Fax:989-723-1257
Practice Address - Street 1:818 W KING ST STE 101
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2159
Practice Address - Country:US
Practice Address - Phone:989-725-8171
Practice Address - Fax:989-723-1257
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301102754207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669714242Medicaid