Individual
DR. ROBERT ALAN MCKISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1201 MICHIGAN AVE, SUITE 270, LOGANSPORT, IN 46947-1580
(574) 722-4921
(574) 739-0520
Mailing address
1201 MICHIGAN AVE, SUITE 270, LOGANSPORT, IN 46947-1580
(574) 722-4921
(574) 739-0520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01051621A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091515
ANTHEM BLUE CROSS
—
01
—
080151650
RAILROAD MEDICARE
—
05
—
200247260
—
IN
01
—
4388483
AETNA INSURANCE
—
Enumeration date
06/22/2005
Last updated
08/03/2011
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