Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 148844 | NY |
NPI | 1518002005 |
---|---|
Provider Name | Robert L Mick |
First Address | Bloomfield, NY 14469-9773 |
Second Address | Rochester, NY 14611-2331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |