Provider Demographics
NPI:1619946324
Name:MICHEL STEPHAN MD PA
Entity Type:Organization
Organization Name:MICHEL STEPHAN MD PA
Other - Org Name:TEXAS SURGERY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:KHAMIS
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:972-226-0405
Mailing Address - Street 1:2540 NTH GALLOWAY AVENUE #101
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-226-0405
Mailing Address - Fax:972-270-4959
Practice Address - Street 1:2540 N GALLOWAY AVE
Practice Address - Street 2:#101
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6306
Practice Address - Country:US
Practice Address - Phone:972-226-0405
Practice Address - Fax:972-270-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8687208600000X
TXF-8687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123330601Medicaid
TX082476501Medicaid
TX123330601Medicaid
TXC22231Medicare UPIN
TX80K801Medicare ID - Type UnspecifiedINDIVIDUAL