Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | L7046 | TX |
NPI | 1104872449 |
---|---|
Provider Name | Dr. Steven Wayne Michelsen |
First Address | Frisco, TX 75035 |
Second Address | Frisco, TX 75035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H93481 | (02) | TX |