Provider Demographics
NPI:1619913399
Name:MICHAELIS, BARBARA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MICHAELIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62668 W CATCHING RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-7333
Mailing Address - Country:US
Mailing Address - Phone:541-404-1021
Mailing Address - Fax:
Practice Address - Street 1:94220 4TH ST
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-7772
Practice Address - Country:US
Practice Address - Phone:541-247-3974
Practice Address - Fax:541-247-2435
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD220972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134265Medicaid
OR134265Medicaid
AKMD3189RMedicaid
WA8330276Medicaid
ORP00383040Medicare PIN
OR130008Medicare PIN
AKMD6546RMedicaid
AKMD3189RMedicaid
OR161121Medicare PIN
ORP00202432Medicare PIN
ORP00208294Medicare PIN
OR130035Medicare PIN