Provider Demographics
NPI:1689835993
Name:HERNANDEZ, MIGUEL ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ADRIAN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13737 NOEL RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1374
Mailing Address - Country:US
Mailing Address - Phone:469-518-4823
Mailing Address - Fax:
Practice Address - Street 1:13737 NOEL RD STE 1600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-1374
Practice Address - Country:US
Practice Address - Phone:469-518-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3636207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3059776-01Medicaid
TX305977602Medicaid
Z145807Medicare PIN
Z145808Medicare PIN
TX334889YQNKMedicare PIN
P01193357Medicare PIN
TX305977602Medicaid