Provider Demographics
NPI:1750322970
Name:ROBERTS, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
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 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4370 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1056
Practice Address - Country:US
Practice Address - Phone:615-928-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131704207P00000X
KY38264207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
TN3072473OtherBLUE CROSS
TN3809727Medicaid
SC232902Medicaid
TNP00233191OtherMEDICARE RAILROAD
TN3094174OtherBLUE CROSS
TN3809728Medicaid
MS05873366Medicaid
TNP00292503OtherMEDICARE RAILROAD
GA000835238EMedicaid
AL009941819Medicaid
KY50003547OtherPASSPORT HEALTH
KY64004096Medicaid
TNP00101677OtherMEDICARE RAILROAD
TN3809726Medicaid
TN3809728Medicare PIN
TNP00101677OtherMEDICARE RAILROAD