Provider Demographics
NPI:1922237817
Name:SOILEAU, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SOILEAU
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 1:204 S INTERSTATE 35 STE 103
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4125
Mailing Address - Country:US
Mailing Address - Phone:512-693-4041
Mailing Address - Fax:512-290-9226
Practice Address - Street 1:204 S INTERSTATE 35 STE 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4125
Practice Address - Country:US
Practice Address - Phone:512-693-4041
Practice Address - Fax:512-290-9226
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP50052084N0400X
MI4301094725390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program