Provider Demographics
NPI:1972699361
Name:OLIVER, MICHAEL EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWIN
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12709 TOEPPERWEIN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233
Mailing Address - Country:US
Mailing Address - Phone:210-646-0133
Mailing Address - Fax:210-646-0144
Practice Address - Street 1:12709 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-646-0133
Practice Address - Fax:210-646-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG22002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0737886OtherAETNA HMO
C20028Medicare UPIN
0737886OtherAETNA HMO