Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | Q6234 | TX |
NPI | 1447517016 |
---|---|
Provider Name | Michelle Phi Medel |
First Address | Tyler, TX 75701-1951 |
Second Address | Tyler, TX 75701-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 11/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1447517016 | NPI (01) | TX |