Provider Demographics
NPI:1033128988
Name:COSELLI, MICHAEL POOL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:POOL
Last Name:COSELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 1608
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2736
Mailing Address - Country:US
Mailing Address - Phone:713-796-1608
Mailing Address - Fax:713-796-1620
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 1608
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2736
Practice Address - Country:US
Practice Address - Phone:713-796-1608
Practice Address - Fax:713-796-1620
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG4933208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000B22Q8Medicaid
TXP000B22Q8Medicaid
TX00B22QMedicare ID - Type Unspecified