Provider Demographics
NPI:1831381458
Name:CORDOBA KISSEE, MICHELLE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:CORDOBA KISSEE
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 2646
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2646
Mailing Address - Country:US
Mailing Address - Phone:956-362-5650
Mailing Address - Fax:956-362-2574
Practice Address - Street 1:2609 MICHAELANGELO DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1417
Practice Address - Country:US
Practice Address - Phone:956-362-5650
Practice Address - Fax:956-362-2574
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41885207RE0101X, 207RE0101X
TXP7092207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468517Medicaid
TX333675205Medicaid
TX333675206OtherMEDICAID-CSHCN
AZZ148195Medicare PIN
TX333675205Medicaid
TX311533YNG9Medicare PIN