Provider Demographics
NPI:1740862200
Name:YOUNG, EWELINA ANNA (MD)
Entity type:Individual
Prefix:
First Name:EWELINA
Middle Name:ANNA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EWELINA
Other - Middle Name:ANNA
Other - Last Name:MIGUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11515 TOEPPERWEIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3166
Mailing Address - Country:US
Mailing Address - Phone:210-560-4500
Mailing Address - Fax:
Practice Address - Street 1:11505 TOEPPERWEIN RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3140
Practice Address - Country:US
Practice Address - Phone:210-560-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXV1308208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program