Provider Demographics
NPI:1720086648
Name:MICHAELS, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
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 1:610 COUNTY ROAD 337
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-3928
Mailing Address - Country:US
Mailing Address - Phone:432-528-8655
Mailing Address - Fax:
Practice Address - Street 1:610 COUNTY ROAD 337
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:TX
Practice Address - Zip Code:79562-3928
Practice Address - Country:US
Practice Address - Phone:432-528-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00225437OtherMDCR RR
OH0526658Medicaid
OHC03416Medicare UPIN
OH0526658Medicaid
OHMI0622765Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #