Healthcare Provider Details

I. General information

NPI: 1518002005
Provider Name (Legal Business Name): ROBERT L MICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 W MAIN ST
ROCHESTER NY
14611-2331
US

IV. Provider business mailing address

7444 WEILAND RD
BLOOMFIELD NY
14469-9773
US

V. Phone/Fax

Practice location:
  • Phone: 585-279-5412
  • Fax: 585-529-5121
Mailing address:
  • Phone: 585-657-7228
  • Fax: 585-657-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number148844
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number148844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: