Provider Demographics
NPI:1629527726
Name:MICHAEL C PERCENTI, DPM PLLC
Entity Type:Organization
Organization Name:MICHAEL C PERCENTI, DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERCENTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:409-722-4141
Mailing Address - Street 1:7980 ANCHOR DR
Mailing Address - Street 2:STE # 700B
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8266
Mailing Address - Country:US
Mailing Address - Phone:409-722-4141
Mailing Address - Fax:409-722-2788
Practice Address - Street 1:7980 ANCHOR DR
Practice Address - Street 2:STE # 700B
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8266
Practice Address - Country:US
Practice Address - Phone:409-722-4141
Practice Address - Fax:409-722-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1891213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty