Provider Demographics
NPI:1730281544
Name:MICHELETTI, GILDO ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:GILDO
Middle Name:ANTHONY
Last Name:MICHELETTI
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 1:1213 HERMANN DR
Mailing Address - Street 2:#540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:713-521-1137
Mailing Address - Fax:713-520-9243
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:#540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-521-1137
Practice Address - Fax:713-520-9243
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2738207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CB17Medicaid
TX00CB17Medicare ID - Type Unspecified
TX00CB17Medicaid