Provider Demographics
NPI:1184657678
Name:ZANIEWSKI, MICHELLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:ZANIEWSKI
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 1:17070 RED OAK DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2619
Mailing Address - Country:US
Mailing Address - Phone:281-580-7401
Mailing Address - Fax:281-580-5665
Practice Address - Street 1:17070 RED OAK DR
Practice Address - Street 2:SUITE 309
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2619
Practice Address - Country:US
Practice Address - Phone:281-580-7401
Practice Address - Fax:281-580-5665
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27782Medicare UPIN
00SL57Medicare ID - Type Unspecified