Provider Demographics
NPI:1124064506
Name:RODNEY D MICHAELS MD PC
Entity type:Organization
Organization Name:RODNEY D MICHAELS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-589-0565
Mailing Address - Street 1:1585 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4345
Mailing Address - Country:US
Mailing Address - Phone:503-589-0565
Mailing Address - Fax:503-589-0463
Practice Address - Street 1:1585 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4345
Practice Address - Country:US
Practice Address - Phone:503-589-0565
Practice Address - Fax:503-589-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16437207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386691061OtherDR MICHAELS NPI
OR058292Medicaid
1699715227OtherBARBARA BRITSCH NPI
OR137534Medicaid
OR113028Medicare ID - Type UnspecifiedSOPHIE SPARLING MEDICARE
OR058292Medicaid
OR137534Medicaid
1386691061OtherDR MICHAELS NPI
1699715227OtherBARBARA BRITSCH NPI
OR101092Medicare ID - Type UnspecifiedGROUP BILLINGER