Provider Demographics
NPI:1124586862
Name:MIDESSA INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:MIDESSA INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-935-7916
Mailing Address - Street 1:4311 ANDREWS HWY # B
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4823
Mailing Address - Country:US
Mailing Address - Phone:877-935-7916
Mailing Address - Fax:
Practice Address - Street 1:4311 ANDREW HWY
Practice Address - Street 2:B
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4823
Practice Address - Country:US
Practice Address - Phone:877-935-7916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty