Healthcare Provider Details

I. General information

NPI: 1386691061
Provider Name (Legal Business Name): RODNEY DOUGLAS MICHAELS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 LIBERTY ST SE
SALEM OR
97302-4345
US

IV. Provider business mailing address

1585 LIBERTY ST SE
SALEM OR
97302-4345
US

V. Phone/Fax

Practice location:
  • Phone: 503-589-0565
  • Fax: 503-589-0463
Mailing address:
  • Phone: 503-589-0565
  • Fax: 503-589-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD16437
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD16437
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD16437
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: