Provider Demographics
NPI:1639303621
Name:MIKAELA RUSH, M.D., P.A.
Entity Type:Organization
Organization Name:MIKAELA RUSH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKAELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-260-9192
Mailing Address - Street 1:1401 MEDICAL PKWY BLDG B
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7642
Mailing Address - Country:US
Mailing Address - Phone:512-260-9191
Mailing Address - Fax:512-260-9192
Practice Address - Street 1:1401 MEDICAL PKWY BLDG B
Practice Address - Street 2:SUITE 410
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7642
Practice Address - Country:US
Practice Address - Phone:512-260-9191
Practice Address - Fax:512-260-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1870207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty