Healthcare Provider Details

I. General information

NPI: 1245868678
Provider Name (Legal Business Name): THEODORE ROBAK III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 HOUSTON NORTHCUTT BLVD # 1011
MOUNT PLEASANT SC
29464-3446
US

IV. Provider business mailing address

845 HOUSTON NORTHCUTT BLVD # 1011
MOUNT PLEASANT SC
29464-3446
US

V. Phone/Fax

Practice location:
  • Phone: 843-888-2118
  • Fax:
Mailing address:
  • Phone: 843-888-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number93171
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number93171
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD481289
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: