Provider Demographics
NPI:1336138650
Name:ROBERTS, WILLIAM MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5882
Practice Address - Street 1:4099 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8947
Practice Address - Country:US
Practice Address - Phone:812-491-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051657A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000501009OtherBCBS - DEACONESS GATEWAY
IN200026050Medicaid
IN000000197943OtherBC
IL405981960 PYE1Medicaid
INP00272899OtherMEDICARE RAILROAD-DEACONESS HOSP
KY64041361Medicaid
IN000000197004OtherBCBS - DEACONESS MARY ST
IN234380LMedicare PIN
INP00272899OtherMEDICARE RAILROAD-DEACONESS HOSP
KY64041361Medicaid