Provider Demographics
NPI:1962472365
Name:COURTINES, MICHEL-ALEXIS ROMAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL-ALEXIS
Middle Name:ROMAIN
Last Name:COURTINES
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 1:3851 ROGER BROOKE DRIVE
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER - MCHE - QD
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-878-5035
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DRIVE
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER - MCHE-QD
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-08-29
Deactivation Date:2022-06-08
Deactivation Code:
Reactivation Date:2022-08-29
Provider Licenses
StateLicense IDTaxonomies
TXK7701207R00000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369515701Medicaid
TX369515702OtherCSHCN
TX369515701Medicaid