Provider Demographics
NPI:1629396114
Name:RESTER, MICHELLE MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARTIN
Last Name:RESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 ARBOR VIEW PL
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3276
Mailing Address - Country:US
Mailing Address - Phone:972-772-6128
Mailing Address - Fax:
Practice Address - Street 1:102 S 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3793
Practice Address - Country:US
Practice Address - Phone:972-772-6128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine