Provider Demographics
NPI:1578009767
Name:BROUSE, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BROUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8408 PRESTON RD
Mailing Address - Street 2:STE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8408 PRESTON RD
Practice Address - Street 2:STE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3327
Practice Address - Country:US
Practice Address - Phone:214-618-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80669237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist