Provider Demographics
NPI:1003007287
Name:GINN, MICHAELA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:ELIZABETH
Last Name:GINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 MEMORIAL DRIVE
Mailing Address - Street 2:#278
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079
Mailing Address - Country:US
Mailing Address - Phone:713-591-3555
Mailing Address - Fax:
Practice Address - Street 1:13214 INDIAN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:713-591-3555
Practice Address - Fax:661-321-3286
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77631207R00000X
NC224626207R00000X
OH35.130643207R00000X
WI67083-20207R00000X
TXN8098207R00000X
CAA111803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4651532834OtherMYUTMB 4651532834