Provider Demographics
NPI:1750365185
Name:DARNELL, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DARNELL
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 1:7100 OAKMONT BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3911
Mailing Address - Country:US
Mailing Address - Phone:972-566-3040
Mailing Address - Fax:682-499-5921
Practice Address - Street 1:7100 OAKMONT BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3911
Practice Address - Country:US
Practice Address - Phone:972-566-3040
Practice Address - Fax:682-499-5921
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2936208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180531901Medicaid
TX946247OtherMEDICARE PTAN
TX8F2708Medicare PIN