Provider Demographics
NPI:1225070543
Name:PELLEGRINI, MICHAEL FEDERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FEDERICO
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 203783
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78720-3783
Mailing Address - Country:US
Mailing Address - Phone:512-459-5204
Mailing Address - Fax:512-369-4074
Practice Address - Street 1:11500 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3854
Practice Address - Country:US
Practice Address - Phone:512-459-5204
Practice Address - Fax:512-369-4074
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ6655OtherMEDICAL LICENSE
TXS0097461OtherDPS NUMBER
TXBP4873560OtherDEA
TXBP4873560OtherDEA