1154345593 NPI number — MICHAEL W STAVINOHA MD PA

Table of content: MICHAEL W STAVINOHA MD PA (NPI 1154345593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154345593 NPI number — MICHAEL W STAVINOHA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAVINOHA
Provider First Name:
MICHAEL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PA
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:
1154345593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1631 NORTH LOOP WEST
Provider Second Line Business Mailing Address:
SUITE 655
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77008-1599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-869-8200
Provider Business Mailing Address Fax Number:
713-867-2013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1631 NORTH LOOP WEST
Provider Second Line Business Practice Location Address:
SUITE 655
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77008-1599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-869-8200
Provider Business Practice Location Address Fax Number:
713-867-2013
Provider Enumeration Date:
07/27/2006

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: 207RG0100X , with the licence number:  G8436 , 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)

  • Identifier: 127858203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com