Provider Demographics
NPI:1073632147
Name:PINKMAN, MICHELLE (TX LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PINKMAN
Suffix:
Gender:F
Credentials:TX LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 BROOKHILL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3574
Mailing Address - Country:US
Mailing Address - Phone:512-693-9217
Mailing Address - Fax:
Practice Address - Street 1:1700 S LAMAR BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8962
Practice Address - Country:US
Practice Address - Phone:512-577-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist