Provider Demographics
NPI:1891730685
Name:WYKO, ROBERT B (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:WYKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:180 PATRICIA AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8103
Practice Address - Country:US
Practice Address - Phone:727-733-4193
Practice Address - Fax:813-635-2628
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3673208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0105064OtherUNITED HEALTHCARE
FL1679215OtherCIGNA
FL123317OtherHUMANA
FL593709395OtherTAX ID
FL010065622OtherRAILROAD MEDICARE
FL021226000Medicaid
FL0100584OtherEVERCARE
FL211531OtherAVMED
FL5352090OtherAETNA
FL82091OtherBCBS
FL211531OtherAVMED
FL82091YMedicare ID - Type Unspecified
FL021226000Medicaid