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NPI Code Detail

MEDICARE: DR. ROBERT A DICKENS MD

MEDICARE: DR. ROBERT A DICKENS MD
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
12084P0800XPsychiatry Physician30285020WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831173673
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT A DICKENS MD
Provider Business Mailing Address
First Line : PO BOX 215
Second Line :
City : MANITOWOC
State : WI
Zip : 54221-0125
Country : US
Telephone Number : 920-684-8101
Fax Number : 920-684-1224
Provider Business Practice Location Address
First Line : 4555 W SCHROEDER DR
Second Line : SUITE 170
City : MILWAUKEE
State : WI
Zip : 53223-1475
Country : US
Telephone Number : 414-365-3210
Fax Number : 414-365-3225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 06/12/2008

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