MEDICARE: DR. RODNEY DOUGLAS MICHAELS MD

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	174400000X	Specialist	MD16437	OR
2	207R00000X	Internal Medicine Physician	MD16437	OR
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD16437	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386691061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY DOUGLAS MICHAELS MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/03/2010

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