=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306897640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT A. SIVIER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 11/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 MIRABEAU ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45123-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-981-2116
-----------------------------------------------------
Fax | 937-981-9238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4750 HEMPSTEAD STATION DR
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-5164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-875-0136
-----------------------------------------------------
Fax | 937-619-4304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 35.065920
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35065920S
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------