Provider Demographics
NPI:1528009776
Name:STORANDT, MICHELLE LYNN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:STORANDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20642 STONE OAK PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7362
Mailing Address - Country:US
Mailing Address - Phone:210-479-3000
Mailing Address - Fax:210-479-3016
Practice Address - Street 1:20642 STONE OAK PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7362
Practice Address - Country:US
Practice Address - Phone:210-479-3000
Practice Address - Fax:210-479-3016
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0579208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1265475891OtherGROUP NPI
TX169952201Medicaid
TX173321402OtherMEDICAID-GROUP EPSDT
TX173321401OtherMEDICAID-GOUP TPI