Basic Information
| Provider Information | |||||||||
| NPI: | 1215019682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESSING | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GAZALL | ||||||||
| OtherFirstName: | ROBYN | ||||||||
| OtherMiddleName: | DANA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1035 CHARLEVOIX DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | GRAND LEDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488372223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176769788 | ||||||||
| FaxNumber: | 5176763438 | ||||||||
| Practice Location | |||||||||
| Address1: | 935 CHARLEVOIX DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRAND LEDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488372293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173722253 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | BM015681 | MI | N | Allopathic & Osteopathic Physicians | Dermatology | 207NP0225X | BM015681 | MI | N | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 207NS0135X | BM015681 | MI | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207Q00000X | BM015681 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BM9949910 | 01 | MI | DEA LICENSE | OTHER | 5101015681 | 01 | MI | MI STATE LICENSE | OTHER | 5315027997 | 01 | MI | CONTROLLED SUBSTANCE | OTHER |