Provider Demographics
NPI:1629224183
Name:MICHAEL, ROBERT V (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:32214 ELLINGWOOD TRL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9719
Mailing Address - Country:US
Mailing Address - Phone:303-679-2020
Mailing Address - Fax:303-670-2160
Practice Address - Street 1:32214 ELLINGWOOD TRL
Practice Address - Street 2:SUITE 210
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9719
Practice Address - Country:US
Practice Address - Phone:303-679-2020
Practice Address - Fax:303-670-2160
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2012-10-09
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Provider Licenses
StateLicense IDTaxonomies
IL036128750207Q00000X
CO51723207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine