Provider Demographics
NPI:1558526392
Name:MICHAEL AND MICHAEL PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:MICHAEL AND MICHAEL PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,RNC,WHCHP
Authorized Official - Phone:214-707-0092
Mailing Address - Street 1:722 WEEPING WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2534
Mailing Address - Country:US
Mailing Address - Phone:214-707-0092
Mailing Address - Fax:
Practice Address - Street 1:5505 BROADWAY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3670
Practice Address - Country:US
Practice Address - Phone:214-707-0092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544527261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service