1528009776 NPI number — MRS. MICHELLE LYNN STORANDT M.D.

Table of content: MRS. MICHELLE LYNN STORANDT M.D. (NPI 1528009776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528009776 NPI number — MRS. MICHELLE LYNN STORANDT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STORANDT
Provider First Name:
MICHELLE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
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:
MOORE
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528009776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20642 STONE OAK PKWY
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-7362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-479-3000
Provider Business Mailing Address Fax Number:
210-479-3016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20642 STONE OAK PKWY
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-7362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-479-3000
Provider Business Practice Location Address Fax Number:
210-479-3016
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: 208000000X , with the licence number:  M0579 , 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: 1265475891 . This is a "GROUP NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 169952201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173321402 . This is a "MEDICAID-GROUP EPSDT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 173321401 . This is a "MEDICAID-GOUP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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