Provider Demographics
NPI:1558379727
Name:MICHNA, DAVID CLINTON (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CLINTON
Last Name:MICHNA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 LOUIS PASTEUR DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4537
Mailing Address - Country:US
Mailing Address - Phone:210-614-3003
Mailing Address - Fax:210-692-7898
Practice Address - Street 1:7220 LOUIS PASTEUR DR STE 160
Practice Address - Street 2:4319 MEDICAL DR. 131-113
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4535
Practice Address - Country:US
Practice Address - Phone:210-614-3003
Practice Address - Fax:210-692-7898
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1981OtherBCBS PROVIDER NUMBER
TX8B4421Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER