Individual
MICHAEL ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8801 S 101 E AVE, TULSA, OK 74133
(918) 294-4915
(918) 294-4947
Mailing address
PO BOX 26901, OKLAHOMA CITY, OK 73126-0901
(405) 271-4351
(405) 271-8695
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
55476
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
R0087817
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200120020A
—
OK
01
—
900522349
MEDICARE GROUP PIN
OK
Enumeration date
01/19/2006
Last updated
01/24/2022
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