Provider Demographics
NPI:1104838085
Name:UMENGAN, MICHELLE K (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:UMENGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 CHAMPION GRANDVIEW WAY
Mailing Address - Street 2:APT 35305
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8223
Mailing Address - Country:US
Mailing Address - Phone:806-438-1577
Mailing Address - Fax:
Practice Address - Street 1:6500 CHAMPION GRANDVIEW WAY
Practice Address - Street 2:APT 35305
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8223
Practice Address - Country:US
Practice Address - Phone:806-438-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182197710Medicaid
TX182197709Medicaid
TX182197711Medicaid
TX8G8905Medicare PIN