Provider Demographics
NPI:1710404082
Name:ROBERTS, MICHAEL WARREN (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WARREN
Last Name:ROBERTS
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 1:209 PALERMO PL UNIT C
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2821
Mailing Address - Country:US
Mailing Address - Phone:941-488-5300
Mailing Address - Fax:941-412-1003
Practice Address - Street 1:209 PALERMO PL UNIT C
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2821
Practice Address - Country:US
Practice Address - Phone:941-488-5300
Practice Address - Fax:941-412-1003
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86263207N00000X
FLOS21386207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology