Provider Demographics
NPI:1811231954
Name:ROBERT J KLICKOVICH MD
Entity Type:Organization
Organization Name:ROBERT J KLICKOVICH MD
Other - Org Name:PARADIGM PAIN AND SPINE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KLICKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-282-2024
Mailing Address - Street 1:47 CAVALIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 CAVALIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3969
Practice Address - Country:US
Practice Address - Phone:859-282-2024
Practice Address - Fax:859-282-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41232208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty