Provider Demographics
NPI:1972965655
Name:NICKE, ROBERT JOHN (MD, JD, MBA)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:NICKE
Suffix:
Gender:M
Credentials:MD, JD, MBA
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:J
Other - Last Name:NICKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, JD, MBA
Mailing Address - Street 1:1608 INVERNESS CLFS
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-3729
Mailing Address - Country:US
Mailing Address - Phone:205-910-1095
Mailing Address - Fax:
Practice Address - Street 1:1608 INVERNESS CLFS
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-3729
Practice Address - Country:US
Practice Address - Phone:205-910-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32022207L00000X
MDD30387207L00000X
FLME39499207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology