Provider Demographics
NPI:1417991910
Name:MARLOW, MICHAEL DEAN (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEAN
Last Name:MARLOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 ST LUKES WAY
Mailing Address - Street 2:STE 110
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4103
Mailing Address - Country:US
Mailing Address - Phone:936-321-4800
Mailing Address - Fax:936-273-4833
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:STE 110
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4103
Practice Address - Country:US
Practice Address - Phone:936-321-4800
Practice Address - Fax:936-273-4833
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A4449OtherBCBS
TX157417003Medicaid
TX8M3086OtherBCBS
TX157417004Medicaid
TXH36711Medicare UPIN
TX8B7188Medicare PIN
TX8F1192Medicare PIN
TX8A4449Medicare ID - Type Unspecified
TXP00195256Medicare PIN