MEDICARE: RODNEY D MICHAELS MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD16437	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1386691061	OTHER	DR MICHAELS NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1699715227	OTHER	BARBARA BRITSCH NPI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124064506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RODNEY D MICHAELS MD PC

Provider Business Mailing Address
First Line	:	1585 LIBERTY ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4345
Country	:	US
Telephone Number	:	503-589-0565
Fax Number	:	503-589-0463

Provider Business Practice Location Address
First Line	:	1585 LIBERTY ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4345
Country	:	US
Telephone Number	:	503-589-0565
Fax Number	:	503-589-0463

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RODNEY DOUGLAS MICHAELS
Credential	:	MD
Telephone Number	:	503-589-0565

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/16/2010

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