Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 74731 | MA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 74731 | TX |
NPI | 1144334822 |
---|---|
Provider Name | Simon K. Michael |
First Address | Austin, TX 78705-1006 |
Second Address | Austin, TX 78705-1006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 14/01/2009 |