Provider Demographics
NPI:1467783027
Name:DR. MICHAEL DUCHAMP DO, PA
Entity Type:Organization
Organization Name:DR. MICHAEL DUCHAMP DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-772-8577
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0506
Mailing Address - Country:US
Mailing Address - Phone:972-772-8577
Mailing Address - Fax:972-772-8575
Practice Address - Street 1:930 W RALPH HALL PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6665
Practice Address - Country:US
Practice Address - Phone:972-772-8577
Practice Address - Fax:972-772-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDOH9894207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDOH9894OtherLICENSE/PERMIT
TX096762202Medicaid
TX096762202Medicaid