Provider Demographics
NPI:1336191873
Name:HIX, ROBERT BARON (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BARON
Last Name:HIX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:MSB 015
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1650
Mailing Address - Country:US
Mailing Address - Phone:269-226-6933
Mailing Address - Fax:269-226-6949
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:MSB 015
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1650
Practice Address - Country:US
Practice Address - Phone:269-226-6933
Practice Address - Fax:269-226-6949
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010180207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114155915Medicaid
MI700G560080OtherBCBS GROUP-THREE RIVERS HEALTH
MIRH010180OtherBLUE CROSS BLUE SHIELD
MI4798521-11Medicaid
MI113232751Medicaid
MI114155915Medicaid
MI0M90900012Medicare PIN
MI930034954Medicare PIN
MIG56008 102Medicare ID - Type UnspecifiedTHREE RIVERS HEALTH
MI4798521-11Medicaid
MI230015Medicare Oscar/Certification