Healthcare Provider Details

I. General information

NPI: 1346653722
Provider Name (Legal Business Name): ROBERT PAULSEN MICHAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 07/21/2022
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N 5TH ST
LEBANON OR
97355-2875
US

IV. Provider business mailing address

PO BOX 1193
CORVALLIS OR
97339-1193
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6282
  • Fax: 541-812-2038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number184207
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116026909
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: