Basic Information
| Provider Information | |||||||||
| NPI: | 1063536993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELA CRUZ | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2383 TWIN LAKES DR | ||||||||
| Address2: | APT. 2A | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481971479 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5333 MCAULEY DR | ||||||||
| Address2: | REICHERT HEALTH CENTER, SUITE 3009 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481971014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347123980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2007 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301086225 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.