Provider Demographics
NPI:1326044884
Name:GARRETT, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 BEE CAVES RD STE K201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4728
Mailing Address - Country:US
Mailing Address - Phone:512-865-4900
Mailing Address - Fax:
Practice Address - Street 1:5656 BEE CAVES RD STE K201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4728
Practice Address - Country:US
Practice Address - Phone:512-865-4900
Practice Address - Fax:877-633-7612
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7923207Q00000X
IN01049028A146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN930126176OtherMEDICARE RR
IN200217490Medicaid
IN200217490Medicaid
INH10657Medicare UPIN