Provider Demographics
NPI:1649370917
Name:ROBUSTO, KIM (DO)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:ROBUSTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92997
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-2997
Mailing Address - Country:US
Mailing Address - Phone:330-425-2212
Mailing Address - Fax:330-425-2779
Practice Address - Street 1:8819 COMMONS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4102
Practice Address - Country:US
Practice Address - Phone:330-425-2212
Practice Address - Fax:330-425-2779
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34008135R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I23471Medicare UPIN