Provider Demographics
NPI:1225110232
Name:MCHANN, MICHAEL DONOVAN (OPA-C, LSA,CST/CFA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DONOVAN
Last Name:MCHANN
Suffix:
Gender:M
Credentials:OPA-C, LSA,CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 ST PLACIDIA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2640
Mailing Address - Country:US
Mailing Address - Phone:281-414-3409
Mailing Address - Fax:
Practice Address - Street 1:6314 ST PLACIDIA DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2640
Practice Address - Country:US
Practice Address - Phone:281-414-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00046363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3126400OtherAETNA PROVIDER ID
TX8N3529OtherBLUE CROSS BLUE SHIELD