Provider Demographics
NPI:1821061078
Name:MACEDO, THANILA DE ARAUJO (MD)
Entity Type:Individual
Prefix:
First Name:THANILA
Middle Name:DE ARAUJO
Last Name:MACEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THANILA
Other - Middle Name:
Other - Last Name:DE ARAUJO MACEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-7671
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN407502085R0202X, 2085U0001X
TXS68812085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN525026900Medicaid
MN300002822Medicare ID - Type Unspecified
MN525026900Medicaid
G79477Medicare UPIN