Healthcare Provider Details

I. General information

NPI: 1568441020
Provider Name (Legal Business Name): ROBERT D FICALORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SAINT MARYS DR # 300
EVANSVILLE IN
47714-0511
US

IV. Provider business mailing address

801 SAINT MARYS DR # 300
EVANSVILLE IN
47714-0511
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number01081089A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMED-PHY-LIC-28236
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01081089A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number01081089A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: