Provider Demographics
NPI:1700908175
Name:HARKINS, MICHAEL BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:HARKINS
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 1:455 SCHOOL ST STE 10
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4594
Mailing Address - Country:US
Mailing Address - Phone:281-351-5409
Mailing Address - Fax:281-351-2803
Practice Address - Street 1:455 SCHOOL ST STE 10
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4594
Practice Address - Country:US
Practice Address - Phone:281-351-5409
Practice Address - Fax:281-351-2803
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2483208600000X
LA020602208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030156604Medicaid
TX8A1692Medicare ID - Type Unspecified
F97509Medicare UPIN