Provider Demographics
NPI:1821196932
Name:WINNIE, MICHAEL GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GLENN
Last Name:WINNIE
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 1:5920 SARATOGA BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4120
Mailing Address - Country:US
Mailing Address - Phone:361-985-9850
Mailing Address - Fax:361-985-9853
Practice Address - Street 1:5920 SARATOGA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4120
Practice Address - Country:US
Practice Address - Phone:361-985-9850
Practice Address - Fax:361-985-9853
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20700000XMedicaid
TX1821196932OtherCOMMERCIAL INSURANCE
TX1821196932Medicaid
TX1649457276Medicaid
TX1649457276OtherCOMMERCIAL INSURANCE
TX157386702Medicaid
TX127508307Medicaid