Provider Demographics
NPI:1649258971
Name:MICHAELSON, ROBERT S (DO)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:MICHAELSON
Suffix:
Gender:M
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:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78296-1716
Mailing Address - Country:US
Mailing Address - Phone:210-558-6288
Mailing Address - Fax:
Practice Address - Street 1:7500 BARLITE BLVD.
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1338
Practice Address - Country:US
Practice Address - Phone:210-921-3493
Practice Address - Fax:210-921-3533
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3980- M2083A0100X
TXN86912083P0011X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine