Provider Demographics
NPI:1558482257
Name:HORODA, MICHAEL JOHATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHATHAN
Last Name:HORODA
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 1:2001 W AIRPORT FWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6006
Mailing Address - Country:US
Mailing Address - Phone:972-659-1235
Mailing Address - Fax:972-257-9748
Practice Address - Street 1:2001 W AIRPORT FWY
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6006
Practice Address - Country:US
Practice Address - Phone:972-659-1235
Practice Address - Fax:972-257-9748
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2469261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2136Medicare ID - Type Unspecified
TXE18087Medicare UPIN