Basic Information
Provider Information
NPI: 1740338458
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAWLEY
FirstName: ROBERT
MiddleName: C.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: HENRY FORD HEALTH SYSTEM
Address2: 2799 WEST GRAND BOULEVARD
City: DETROIT
State: MI
PostalCode: 48202
CountryCode: US
TelephoneNumber: 3139162436
FaxNumber:  
Practice Location
Address1: HENRY FORD HEALTH SYSTEM
Address2: 2799 WEST GRAND BOULEVARD
City: DETROIT
State: MI
PostalCode: 48202
CountryCode: US
TelephoneNumber: 3139162436
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/08/2007
LastUpdateDate: 06/22/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZH0000X045809MIY Allopathic & Osteopathic PhysiciansPathologyHematology
207ZP0101X045809MIN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology

ID Information
IDTypeStateIssuerDescription
700H26227001 BLUE CROSS-BLUE CROSSOTHER
RH04580901 COMMERCIAL-COMMERCIAL NUMBEROTHER
RH04580901 CHAMPUS-CHAMPUSOTHER
15047811005MI MEDICAID


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