Provider Demographics
NPI:1760565329
Name:DARTSON, MICAELA (DPM)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:DARTSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4393
Mailing Address - Country:US
Mailing Address - Phone:214-725-9663
Mailing Address - Fax:972-548-1079
Practice Address - Street 1:4101 MCEWEN RD
Practice Address - Street 2:STE 625
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5112
Practice Address - Country:US
Practice Address - Phone:214-221-9116
Practice Address - Fax:214-219-1120
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1306213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130986606Medicaid
TX0011AWOtherBLUE SHIELD
TXP00606710OtherRAILROAD MEDICARE
TXU57839Medicare UPIN
TX0011AWOtherBLUE SHIELD
TXP00606710OtherRAILROAD MEDICARE