Provider Demographics
NPI:1164532180
Name:MICKEL, ROBERT ALLEN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:MICKEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1448
Mailing Address - Country:US
Mailing Address - Phone:415-999-2884
Mailing Address - Fax:
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:SUITE 505
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-751-4914
Practice Address - Fax:415-751-1414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43934207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G439340Medicare ID - Type Unspecified