1285675264 NPI number — STEPHANIE SMOLEN MICHEL M.D.

Table of content: STEPHANIE SMOLEN MICHEL M.D. (NPI 1285675264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285675264 NPI number — STEPHANIE SMOLEN MICHEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHEL
Provider First Name:
STEPHANIE
Provider Middle Name:
SMOLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMOLEN
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285675264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 OAKWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-4068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-244-3698
Provider Business Mailing Address Fax Number:
512-244-0214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 OAKWOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-4068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-244-3698
Provider Business Practice Location Address Fax Number:
512-244-0214
Provider Enumeration Date:
06/09/2006

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: 207V00000X , with the licence number:  M4355 , 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: 184964803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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