MEDICARE: DR. ROBERT E DICKS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01022713A	IN

General Provider Information

NPI Number	:	1134193188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E DICKS M.D.

Provider Business Mailing Address
First Line	:	701 E COUNTY LINE RD
Second Line	:	SUITE 250
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1072
Country	:	US
Telephone Number	:	317-882-0535
Fax Number	:	317-882-0173

Provider Business Practice Location Address
First Line	:	701 E COUNTY LINE RD
Second Line	:	SUITE 250
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1072
Country	:	US
Telephone Number	:	317-882-0535
Fax Number	:	317-882-0173

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/15/2016

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