Provider Demographics
NPI:1760657167
Name:MICHAEL J PENDLETON, MD, PA
Entity Type:Organization
Organization Name:MICHAEL J PENDLETON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-985-1221
Mailing Address - Street 1:PO BOX 3808
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3808
Mailing Address - Country:US
Mailing Address - Phone:361-985-1221
Mailing Address - Fax:361-985-1295
Practice Address - Street 1:4300 S SPID DR
Practice Address - Street 2:33
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4433
Practice Address - Country:US
Practice Address - Phone:361-985-1221
Practice Address - Fax:361-985-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0013MTOtherBCBS GROUP NUMBER
TX611887Medicare PIN