Provider Demographics
NPI:1407021090
Name:ST CLAIR, MICHAEL ARDEN (CST/CFA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ARDEN
Last Name:ST CLAIR
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 STEADTREE PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4451
Mailing Address - Country:US
Mailing Address - Phone:210-771-8506
Mailing Address - Fax:210-957-3583
Practice Address - Street 1:13910 STEADTREE PASS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4451
Practice Address - Country:US
Practice Address - Phone:210-771-8506
Practice Address - Fax:210-957-3583
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94980246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant