Provider Demographics
NPI:1447218409
Name:SEBESTA, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SEBESTA
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 1:2000 TRANS MOUNTAIN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3601
Mailing Address - Country:US
Mailing Address - Phone:915-271-4586
Mailing Address - Fax:915-271-4587
Practice Address - Street 1:2000 TRANS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911
Practice Address - Country:US
Practice Address - Phone:915-271-4586
Practice Address - Fax:915-271-4587
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056794208800000X
TXP2784208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303735001Medicaid
TN1512958Medicaid
TNBCBSTOther4225024
TNBCBSTOther4225024
TXTXB159152Medicare PIN
TN1512958Medicaid