Provider Demographics
NPI:1083686612
Name:PASSANANTE, MICHAEL VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VINCENT
Last Name:PASSANANTE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1441 N. BECKLEY
Mailing Address - Street 2:METHODIST--PHYSICIANS EMERGENCY CARE ASSOCIATION
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-942-5733
Mailing Address - Fax:214-942-6115
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:METHODIST--PHYSICIANS EMERGENCY CARE ASSOCIATED
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-942-5733
Practice Address - Fax:214-942-6115
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-12-28
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Provider Licenses
StateLicense IDTaxonomies
TXL8469207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH63377Medicare UPIN