Provider Demographics
NPI:1881733897
Name:SPECK, MICHAEL CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:SPECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1892 W US HWY 290
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4701
Mailing Address - Country:US
Mailing Address - Phone:830-304-1666
Mailing Address - Fax:830-304-1665
Practice Address - Street 1:1892 W US HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-6644
Practice Address - Country:US
Practice Address - Phone:830-304-1666
Practice Address - Fax:830-304-1665
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9648208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology