Provider Demographics
NPI:1316133648
Name:SICA, ROBERTO ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ALEJANDRO
Last Name:SICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:840 S WOOD STREET SUITE 820-E M/C 713
Mailing Address - Street 2:713 837 CSB
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-9424
Mailing Address - Fax:
Practice Address - Street 1:101 PAGE STREET
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-961-5919
Practice Address - Fax:508-961-5916
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA242439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine