Provider Demographics
NPI:1841258175
Name:SPAGNUOLO, MICHAEL WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:SPAGNUOLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N LAURENT ST STE 410
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5469
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-371-7090
Practice Address - Street 1:300 N HIGHLAND AVE STE 415
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7390
Practice Address - Country:US
Practice Address - Phone:903-892-3696
Practice Address - Fax:903-893-9514
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015054207X00000X
TXP5305207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DK059ZOtherMEDICARE PTAN
155719Medicare UPIN