Provider Demographics
NPI:1598791394
Name:SOPKO, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SOPKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:334 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3464
Mailing Address - Country:US
Mailing Address - Phone:859-957-1080
Mailing Address - Fax:859-957-1085
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1393
Practice Address - Country:US
Practice Address - Phone:859-431-0090
Practice Address - Fax:859-431-3168
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY18590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080092519OtherRAILROAD MEDICARE
OH0993466Medicaid
KYP00856636OtherRAILROAD MEDICARE
KY64185903Medicaid
KYC72326Medicare UPIN
KY64185903Medicaid
KY008580055Medicare PIN