Provider Demographics
NPI:1649204306
Name:KLICKOVICH, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:KLICKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2010
Mailing Address - Country:US
Mailing Address - Phone:859-282-2024
Mailing Address - Fax:859-282-6747
Practice Address - Street 1:7000 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2010
Practice Address - Country:US
Practice Address - Phone:859-282-2024
Practice Address - Fax:859-282-6747
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41232207LP2900X, 208VP0014X
OH35094827208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100038250Medicaid
OH3091372Medicaid
OHP00883052Medicare PIN
OHKL4304841Medicare PIN