Provider Demographics
NPI:1477884054
Name:SCHLOTTERBACK, MIKEL (PA)
Entity Type:Individual
Prefix:MR
First Name:MIKEL
Middle Name:
Last Name:SCHLOTTERBACK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N ALAMO RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2215
Mailing Address - Country:US
Mailing Address - Phone:956-782-6611
Mailing Address - Fax:956-782-1822
Practice Address - Street 1:122 N ALAMO RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2215
Practice Address - Country:US
Practice Address - Phone:956-782-6611
Practice Address - Fax:956-782-1822
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant