1114151289 NPI number — MR. MICHAEL G ANASTOS P.T.

Table of content: MR. MICHAEL G ANASTOS P.T. (NPI 1114151289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114151289 NPI number — MR. MICHAEL G ANASTOS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANASTOS
Provider First Name:
MICHAEL
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114151289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18220 STATE HIGHWAY 249 STE 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070-4349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-807-4380
Provider Business Mailing Address Fax Number:
281-501-5999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18220 STATE HIGHWAY 249 STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-807-4380
Provider Business Practice Location Address Fax Number:
281-501-5999
Provider Enumeration Date:
05/05/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1158320 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)