Provider Demographics
NPI:1033101902
Name:GNUECHTEL, MICHAEL M (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:GNUECHTEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293355
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3355
Mailing Address - Country:US
Mailing Address - Phone:830-895-4443
Mailing Address - Fax:830-257-2077
Practice Address - Street 1:310 WESLEY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5822
Practice Address - Country:US
Practice Address - Phone:830-895-4443
Practice Address - Fax:830-257-2077
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8081207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096908102Medicaid
TX742906311OtherTAX ID
TX742906311OtherTAX ID
TX00781GMedicare ID - Type Unspecified