Provider Demographics
NPI:1972772945
Name:ROBERTS, MICAH JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:JAMES
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3838 SAN DIMAS ST STE B201
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1496
Practice Address - Country:US
Practice Address - Phone:661-321-3161
Practice Address - Fax:661-321-3166
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2022-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA13291207RC0000X, 207RC0000X
CA20A13291207RC0001X
WI67211207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology