Provider Demographics
NPI:1417975053
Name:RIFKIN, ROBERT DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:RIFKIN
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 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8086
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-0726
Mailing Address - Fax:314-747-4758
Practice Address - Street 1:4921 PARKVIEW PL STE 8A
Practice Address - Street 2:STE 8A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-0726
Practice Address - Fax:314-747-4758
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO203770508Medicaid
ILENROLLEDMedicaid
MO833810183Medicare PIN
MO060050290Medicare PIN
MO008013346Medicare PIN
IL$$$$$$$$$Medicaid
MO000093029Medicaid