Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 28690 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | Q1227 | TX |
NPI | 1154676518 |
---|---|
Provider Name | Dr. Andrew Victor Michael |
First Address | Cypress, TX 77429-5759 |
Second Address | Cypress, TX 77429-5759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2012 |
Last Update Date | 12/02/2016 |