Provider Demographics
NPI:1780983569
Name:VICHICH, ROBERT DAVID (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:VICHICH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MALLARD CREEK RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4194
Mailing Address - Country:US
Mailing Address - Phone:859-492-0285
Mailing Address - Fax:
Practice Address - Street 1:100 MALLARD CREEK RD
Practice Address - Street 2:SUITE 406
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4194
Practice Address - Country:US
Practice Address - Phone:502-895-4607
Practice Address - Fax:502-895-4586
Is Sole Proprietor?:No
Enumeration Date:2011-03-20
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK37429207P00000X
IN01073793A207P00000X
FLME146686207P00000X
WI1038207Q00000X
KY46956207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine