Provider Demographics
NPI:1568486389
Name:TOLLE, MICHAEL ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADAM
Last Name:TOLLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8440 WALNUT HILL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3816
Mailing Address - Country:US
Mailing Address - Phone:214-363-5660
Mailing Address - Fax:214-373-7030
Practice Address - Street 1:8440 WALNUT HILL LN STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3816
Practice Address - Country:US
Practice Address - Phone:214-363-5660
Practice Address - Fax:214-373-7030
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK43382080P0208X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092308801Medicaid
8K8698Medicare PIN
TX8K8698Medicare PIN
TXG78808Medicare UPIN