Provider Demographics
NPI:1073562336
Name:ROBERTS, MICHELLE L (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 N. LAKE FOREST DR.
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:972-548-0758
Mailing Address - Fax:972-548-0425
Practice Address - Street 1:1872 N. LAKE FOREST DR.
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:972-548-0758
Practice Address - Fax:972-548-0425
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092355901Medicaid
TX824089Medicare ID - Type Unspecified
TX092355901Medicaid