MEDICARE: MICHAEL E ROBERTS PA-C

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	207P00000X	Emergency Medicine Physician	794	CO
2	363A00000X	Physician Assistant	794	CO

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

General Provider Information

NPI Number	:	1861452716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E ROBERTS PA-C

Provider Business Mailing Address
First Line	:	3587 S DAWSON ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-4402
Country	:	US
Telephone Number	:	719-651-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	10355 E ILIFF AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80247-3622
Country	:	US
Telephone Number	:	303-755-4955
Fax Number	:	303-755-4956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/07/2019

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