Provider Demographics
NPI:1609879824
Name:HUME, ROBERT L (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HUME
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N 10TH ST W
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2639
Mailing Address - Country:US
Mailing Address - Phone:715-832-1400
Mailing Address - Fax:715-832-4187
Practice Address - Street 1:1200 N 10TH ST W
Practice Address - Street 2:SUITE A
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2639
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI436-025213ES0131X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391359900019OtherBLUE CROSS BLUE SHIELD
791480582OtherMEDICARE RAILROAD
WI43211400Medicaid
WI82735Medicare PIN
WIT62273Medicare UPIN
WI0135920001Medicare NSC