Provider Demographics
NPI:1861478794
Name:ALDRIDGE, MILISSA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MILISSA
Middle Name:S
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 OLD KATY RD
Mailing Address - Street 2:SUITE 276
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2133
Mailing Address - Country:US
Mailing Address - Phone:713-621-7436
Mailing Address - Fax:713-963-9051
Practice Address - Street 1:7026 OLD KATY RD
Practice Address - Street 2:SUITE 276
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2133
Practice Address - Country:US
Practice Address - Phone:713-621-7436
Practice Address - Fax:713-963-9051
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK02552085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11869180ZMedicaid
G72066Medicare UPIN
TX085496RMedicare ID - Type Unspecified