Provider Demographics
NPI:1811080096
Name:ROBERTS, MYSHEIKA WILLIAMS (MD)
Entity type:Individual
Prefix:DR
First Name:MYSHEIKA
Middle Name:WILLIAMS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYSHEIKA
Other - Middle Name:ROBIN
Other - Last Name:LEMAILE-WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:362 NAICHE CT.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-577-9232
Mailing Address - Fax:
Practice Address - Street 1:240 PARSONS AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-645-6426
Practice Address - Fax:614-645-1753
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH46286Medicare UPIN