Provider Demographics
NPI:1023001906
Name:LIKENS, ROBERT LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:LIKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 STATE ROAD 436
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5341
Mailing Address - Country:US
Mailing Address - Phone:407-831-3456
Mailing Address - Fax:407-831-0209
Practice Address - Street 1:515 STATE ROAD 436
Practice Address - Street 2:SUITE 1000
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5341
Practice Address - Country:US
Practice Address - Phone:407-831-3456
Practice Address - Fax:407-831-0209
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0012977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57016Medicare UPIN
FL59057Medicare ID - Type UnspecifiedMEDICARE NUMBER