Provider Demographics
NPI:1003034414
Name:LITTELL, MICHAEL LON (SA-C, LSA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LON
Last Name:LITTELL
Suffix:
Gender:M
Credentials:SA-C, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 KIRKLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8612
Mailing Address - Country:US
Mailing Address - Phone:281-320-8751
Mailing Address - Fax:713-691-1273
Practice Address - Street 1:9126 KIRKLEIGH ST
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8612
Practice Address - Country:US
Practice Address - Phone:281-320-8751
Practice Address - Fax:713-691-1273
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00295246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist