Provider Demographics
NPI:1386691061
Name:MICHAELS, RODNEY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DOUGLAS
Last Name:MICHAELS
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 1:1585 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
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16437174400000X, 207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137534OtherOR MEDICAID BILLING
OR058292Medicaid
ORCG6835Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
OR058292Medicaid
OR101093Medicare ID - Type Unspecified