Healthcare Provider Details

I. General information

NPI: 1689385692
Provider Name (Legal Business Name): MICHELE ROBERTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15396 N 83RD AVE STE E
PEORIA AZ
85381-5627
US

IV. Provider business mailing address

15396 N 83RD AVE STE E
PEORIA AZ
85381-5627
US

V. Phone/Fax

Practice location:
  • Phone: 480-470-4000
  • Fax: 480-686-8875
Mailing address:
  • Phone: 480-470-4000
  • Fax: 480-686-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9966
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: