Provider Demographics
NPI:1184734766
Name:KOROLEVICH, ROBERT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:KOROLEVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5515 BRYSON DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0921
Mailing Address - Country:US
Mailing Address - Phone:239-593-0086
Mailing Address - Fax:239-593-6965
Practice Address - Street 1:5515 BRYSON DR
Practice Address - Street 2:SUITE 501
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0921
Practice Address - Country:US
Practice Address - Phone:239-593-0086
Practice Address - Fax:239-593-6965
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME58442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66367Medicare UPIN
FL11262Medicare ID - Type Unspecified