Healthcare Provider Details

I. General information

NPI: 1023001906
Provider Name (Legal Business Name): ROBERT LEWIS LIKENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 11/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 STATE ROAD 436 SUITE 1000
CASSELBERRY FL
32707-5341
US

IV. Provider business mailing address

515 STATE ROAD 436 SUITE 1000
CASSELBERRY FL
32707-5341
US

V. Phone/Fax

Practice location:
  • Phone: 407-831-3456
  • Fax: 407-831-0209
Mailing address:
  • Phone: 407-831-3456
  • Fax: 407-831-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0012977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: