Provider Demographics
NPI:1316280167
Name:KICKISH, ROBERT ANTHONY JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:KICKISH
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-281-9065
Mailing Address - Fax:
Practice Address - Street 1:14100 58TH ST N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-9900
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:727-824-8165
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126742208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics