Healthcare Provider Details

I. General information

NPI: 1619351905
Provider Name (Legal Business Name): ROBERT L LIKENS, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

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: DR. ROBERT L LIKENS
Title or Position: PRESIDENT
Credential: MD
Phone: 407-831-3456