Provider Demographics
NPI:1205822954
Name:TIBESAR, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:TIBESAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5901 LINCOLN DR
Mailing Address - Street 2:CBC 2 REV/PE
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:937-426-7667
Mailing Address - Fax:
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-874-1292
Practice Address - Fax:612-813-6889
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN43809207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH41430Medicare UPIN