Provider Demographics
NPI:1134236458
Name:MCMICHAEL, ROBERT W (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:MCMICHAEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2669
Mailing Address - Country:US
Mailing Address - Phone:724-774-6823
Mailing Address - Fax:
Practice Address - Street 1:221 GRANGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2669
Practice Address - Country:US
Practice Address - Phone:724-774-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN189231-L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06429Medicare UPIN
PA163518Medicare ID - Type Unspecified