Provider Demographics
NPI:1073006052
Name:KIDNIE, ROBERT TOMS (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:TOMS
Last Name:KIDNIE
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 1:48 PORTAGE DR
Mailing Address - Street 2:
Mailing Address - City:ASTRA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K8V 5P8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 PORTAGE DR
Practice Address - Street 2:
Practice Address - City:ASTRA
Practice Address - State:ONTARIO
Practice Address - Zip Code:K8V 5P8
Practice Address - Country:CA
Practice Address - Phone:613-392-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS29103207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine