Provider Demographics
NPI:1225063548
Name:HILLSTROM, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:HILLSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8374 MARKET ST
Mailing Address - Street 2:195
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5137
Mailing Address - Country:US
Mailing Address - Phone:941-355-3223
Mailing Address - Fax:941-358-9749
Practice Address - Street 1:5911 N HONORE AVE STE 120
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2605
Practice Address - Country:US
Practice Address - Phone:941-355-3223
Practice Address - Fax:941-358-9749
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54913207Y00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22494Medicare UPIN
FL08465AMedicare ID - Type Unspecified