Provider Demographics
NPI:1952349441
Name:GOSSMAN, MICHELLE JEANINE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANINE
Last Name:GOSSMAN
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 3409
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78691-3409
Mailing Address - Country:US
Mailing Address - Phone:512-202-3830
Mailing Address - Fax:512-354-1106
Practice Address - Street 1:17450 ST LUKES WAY STE 360
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8046
Practice Address - Country:US
Practice Address - Phone:512-202-3830
Practice Address - Fax:512-354-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62693207P00000X
TXN2534207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407331200Medicaid
MD407331200Medicaid
MDL153Medicare ID - Type Unspecified