Provider Demographics
NPI:1295730828
Name:LENIS, MICHAEL FERNANDO (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FERNANDO
Last Name:LENIS
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 1:4616 W HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6300
Mailing Address - Country:US
Mailing Address - Phone:512-324-8960
Mailing Address - Fax:512-324-8906
Practice Address - Street 1:301 SETON PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8002
Practice Address - Country:US
Practice Address - Phone:512-324-4812
Practice Address - Fax:512-324-4728
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8639207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CN860OtherBCBS
TX192863205Medicaid
TX192863208Medicaid
TX8ET185OtherBCBS
TXP01364918OtherRAILROAD MEDICARE
TX192863206Medicaid
TXP00822021OtherRAILROAD MEDICARE
TX192863207Medicaid
TXP00822021OtherRAILROAD MEDICARE
TXTXB117177Medicare PIN
TX329462YMGJMedicare PIN
TX192863205Medicaid
TX329462YL9XMedicare PIN