Provider Demographics
NPI:1275532327
Name:HEIDT, ROBERT SAMUEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:HEIDT
Suffix:JR
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 1:7575 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4346
Mailing Address - Country:US
Mailing Address - Phone:513-232-6677
Mailing Address - Fax:513-232-2522
Practice Address - Street 1:7575 5 MILE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4346
Practice Address - Country:US
Practice Address - Phone:513-232-6677
Practice Address - Fax:513-232-2522
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041019207X00000X
OH35.041019207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000004446OtherANTHEM
OH0481796Medicaid
OH0920337OtherUNITED HEALTHCARE
OH1903783001OtherCIGNA
OH200011150OtherMEDICARE RAILROAD
OH000000004446OtherANTHEM
A83237Medicare UPIN
OH1903783001OtherCIGNA