Provider Demographics
NPI:1477539955
Name:MICHAEL ARCHULETA MD PA
Entity Type:Organization
Organization Name:MICHAEL ARCHULETA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-266-7676
Mailing Address - Street 1:PO BOX 340639
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-0011
Mailing Address - Country:US
Mailing Address - Phone:512-266-7676
Mailing Address - Fax:512-266-4646
Practice Address - Street 1:1100 LAKEWAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4478
Practice Address - Country:US
Practice Address - Phone:512-266-7676
Practice Address - Fax:512-266-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty