Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 31163 | TX |
N | 213EG0000X | General Practice | 31163 | TX |
Y | 1223P0300X | Periodontist | 31163 | TX |
NPI | 1083088736 |
---|---|
Provider Name | Michelle Michaiel |
First Address | Houston, TX 77054-2032 |
Second Address | Houston, TX 77054-2032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2015 |
Last Update Date | 07/12/2018 |