Provider Demographics
NPI: | 1497946685 |
---|---|
Name: | SAAVEDRA, MICHAEL CARL (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MICHAEL |
Middle Name: | CARL |
Last Name: | SAAVEDRA |
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: | PO BOX 603725 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28260-3725 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-575-2625 |
Mailing Address - Fax: | 828-350-2174 |
Practice Address - Street 1: | 11645 ANGUS RD STE A1 |
Practice Address - Street 2: | |
Practice Address - City: | AUSTIN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78759-4100 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-345-7635 |
Practice Address - Fax: | 512-345-1649 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-08-05 |
Last Update Date: | 2023-10-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | N1115 | 207K00000X, 207K00000X |
AZ | 42415 | 207KA0200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | |
No | 207KA0200X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 1P5036 | Other | PTAN |
AZ | Z133333 | Medicare PIN | |
AZ | Z150949 | Medicare PIN |