Provider Demographics
NPI:1801834809
Name:TENERIELLO, MICHAEL GUY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GUY
Last Name:TENERIELLO
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:6204 BALCONES DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4214
Practice Address - Country:US
Practice Address - Phone:512-302-1771
Practice Address - Fax:512-302-9774
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1694207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125745303Medicaid
TX125745302Medicaid
TX8R1566OtherBLUE CROSS OF TEXAS
TX125745307Medicaid
TX125745306Medicaid
TX125745301Medicaid
TX8644K0Medicare PIN
TX8R1566OtherBLUE CROSS OF TEXAS
TX125745307Medicaid
TX980000089Medicare PIN
TX87691KMedicare PIN