Provider Demographics
NPI:1033166368
Name:MUSGROVE, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MUSGROVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SAM BASS RD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4137
Mailing Address - Country:US
Mailing Address - Phone:512-964-6992
Mailing Address - Fax:512-388-0373
Practice Address - Street 1:1201 SAM BASS RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4137
Practice Address - Country:US
Practice Address - Phone:512-964-6992
Practice Address - Fax:512-388-0373
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM33342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1862104-02Medicaid
TX1862104-02Medicaid
TX8F7927Medicare PIN