Robert Alan McKissick, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01051621A Issued in IN

Practice address

1201 Michigan Ave
Suite 270
Logansport, IN 46947-1580

Phone

(574) 722-4921

Fax

(574) 739-0520

NPI assigned

Jun 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312329600000",
    "number": "1699771949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 MICHIGAN AVE",
            "address_2": "SUITE 270",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471580",
            "telephone_number": "574-722-4921",
            "fax_number": "574-739-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 MICHIGAN AVE",
            "address_2": "SUITE 270",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471580",
            "telephone_number": "574-722-4921",
            "fax_number": "574-739-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKISSICK",
        "first_name": "ROBERT",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2011-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01051621A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200247260",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000091515",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INSURANCE",
            "identifier": "4388483",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080151650",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martin'S Super Markets of Logansport LLC
• John Edward Marvel, MD
• Chay McCarty
• Jessica Yvonne McClintock Glover, MD
• Kelsey Jo McCoy, DDS
• Jaiden Marie McMinn
• Josilynn McNeil
• Thomas Jeffory McShannock, LMHC
• Kacey McWherter
• Danny J. Meadows Jr., M.D.

• Family Medicine Physician in Logansport, IN
• Providers in Logansport, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.