Provider Demographics
NPI:1689031619
Name:ROBERT SACKHEIM,M.D.
Entity Type:Organization
Organization Name:ROBERT SACKHEIM,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-637-4645
Mailing Address - Street 1:4601 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2443
Mailing Address - Country:US
Mailing Address - Phone:850-637-4645
Mailing Address - Fax:850-433-8641
Practice Address - Street 1:4601 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2443
Practice Address - Country:US
Practice Address - Phone:850-637-4645
Practice Address - Fax:850-433-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042339208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC29841Medicare UPIN