Provider Demographics
NPI:1710979869
Name:DICKASON, ROBERT H (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:DICKASON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6707 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1536
Mailing Address - Country:US
Mailing Address - Phone:734-676-5353
Mailing Address - Fax:734-676-5524
Practice Address - Street 1:2674 W JEFFERSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2800
Practice Address - Country:US
Practice Address - Phone:734-676-5353
Practice Address - Fax:734-676-5524
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRD006962208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2114889Medicaid
MI05820096OtherBCBS
B43680Medicare UPIN
MIMI4934Medicare PIN