Provider Demographics
NPI:1811972185
Name:CUMMINS, MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
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:PO BOX 5511
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-5511
Mailing Address - Country:US
Mailing Address - Phone:361-551-2565
Mailing Address - Fax:361-551-2568
Practice Address - Street 1:1300 N VIRGINIA ST
Practice Address - Street 2:SUITE 112
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2516
Practice Address - Country:US
Practice Address - Phone:361-551-2565
Practice Address - Fax:361-551-2568
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9250207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016EJOtherBCBS OF TX #
TX029960401Medicaid
TX74-2951453OtherTAX ID #
TX74-2951453OtherTAX ID #
H10719Medicare UPIN