Provider Demographics
NPI:1740210277
Name:SICKINGER, ROBERT GLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLEN
Last Name:SICKINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1989 MIAMISBURG CENTERVILLE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3823
Mailing Address - Country:US
Mailing Address - Phone:937-223-6837
Mailing Address - Fax:937-223-3024
Practice Address - Street 1:113 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1934
Practice Address - Country:US
Practice Address - Phone:937-223-6837
Practice Address - Fax:937-223-3024
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.004355207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0827994Medicaid
OHSI0697621Medicare ID - Type Unspecified
OH0827994Medicaid
OHH023730Medicare PIN