Provider Demographics
NPI:1932467396
Name:DOWNEY, MICHAEL WAYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:DOWNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:245 WEST STATE HIGHWAY 114
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:972-438-4636
Mailing Address - Fax:682-477-4314
Practice Address - Street 1:245 WEST STATE HIGHWAY 114
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:972-438-4636
Practice Address - Fax:682-477-4314
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TX2157213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508338ZU4KMedicare PIN