Provider Demographics
NPI:1932190121
Name:FANTE, ROBERT G (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:FANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4500 E CHERRY CREEK SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1518
Mailing Address - Country:US
Mailing Address - Phone:303-839-1616
Mailing Address - Fax:303-839-1991
Practice Address - Street 1:4500 E CHERRY CREEK SOUTH DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1518
Practice Address - Country:US
Practice Address - Phone:303-839-1616
Practice Address - Fax:303-839-1991
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27845207W00000X, 2082S0099X
WY6502A207W00000X, 2082S0099X
CO371402082S0099X, 207W00000X, 207WX0200X
MI43010673172082S0099X, 207W00000X
NE188812082S0099X, 207W00000X
MA1561042082S0099X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01371400Medicaid
KS100328370CMedicaid
CO01371400Medicaid
COF10269Medicare UPIN
KS100328370CMedicaid
COF10269Medicare UPIN