Healthcare Provider Details

I. General information

NPI: 1043277932
Provider Name (Legal Business Name): ROBERT S MICHAELS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LONGWOOD AVE
BOSTON MA
02115-5728
US

IV. Provider business mailing address

21 WILLOW CRES
BROOKLINE MA
02445-4110
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7318
  • Fax: 617-277-7834
Mailing address:
  • Phone: 617-731-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46515
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: