Provider Demographics
NPI:1144282377
Name:PROBERT, RICHARD CLEAVELIN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLEAVELIN
Last Name:PROBERT
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 1:315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1252
Mailing Address - Country:US
Mailing Address - Phone:812-421-7489
Mailing Address - Fax:812-436-0209
Practice Address - Street 1:25 W DIVISION ST
Practice Address - Street 2:SUITE 400 WEST
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1374
Practice Address - Country:US
Practice Address - Phone:812-436-4501
Practice Address - Fax:812-436-4510
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100248000AMedicaid
IN000000806881OtherANTHEM BCBS
IN200079040DOtherMEDICAID GROUP
IN100248000AMedicaid