Provider Demographics
NPI:1073552345
Name:VALOSIK, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:VALOSIK
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 1:308 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3963
Mailing Address - Country:US
Mailing Address - Phone:615-384-7186
Mailing Address - Fax:615-382-8056
Practice Address - Street 1:664 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:GATLINBURG
Practice Address - State:TN
Practice Address - Zip Code:37738-5435
Practice Address - Country:US
Practice Address - Phone:615-330-5468
Practice Address - Fax:615-382-8056
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD011335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3170852Medicaid
TN144554OtherBLUE CROSS BLUE SHIELD
TN3170852Medicare ID - Type Unspecified
TNB03429Medicare UPIN