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General NPI Number Information
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NPI Number | 1649256348
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Entity Type | Organization
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Legal Business Name | ROBERT D. SIWICKI,D.P.M.,P.A.
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 914A MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6706
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Country | US
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Telephone | 850-862-4119
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Fax | 850-862-5470
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Provider Business Mailing Address
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Address Line | 914A MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6706
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Country | US
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Telephone | 850-862-4119
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Fax | 850-862-5470
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT DAVID SIWICKI
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Credential | D.P.M.
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Telephone | 850-862-4119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | P01110 & P02964
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License Number State | FL
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