Provider Demographics
NPI:1912936279
Name:ROBICHAU, ALYSIA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:NICOLE
Last Name:ROBICHAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:NICOLE
Other - Last Name:FURGATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17183 INTERSTATE 45 S
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3312
Mailing Address - Country:US
Mailing Address - Phone:936-321-8000
Mailing Address - Fax:936-271-0122
Practice Address - Street 1:17183 INTERSTATE 45 S
Practice Address - Street 2:SUITE 210
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3312
Practice Address - Country:US
Practice Address - Phone:936-321-8000
Practice Address - Fax:936-271-0122
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1687207Q00000X
TXM6128207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184230404Medicaid
TXP01792351OtherRR MEDICARE
TXP01792351OtherRR MEDICARE
TX184230404Medicaid
TX298047ZSVEMedicare PIN