Provider Demographics
NPI:1952597395
Name:MICHAEL H ANNABI MDPA
Entity Type:Organization
Organization Name:MICHAEL H ANNABI MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-587-9455
Mailing Address - Street 1:4930 OSBORNE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1041
Mailing Address - Country:US
Mailing Address - Phone:915-587-9455
Mailing Address - Fax:915-587-9410
Practice Address - Street 1:4930 OSBORNE DR
Practice Address - Street 2:BLDG. A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1041
Practice Address - Country:US
Practice Address - Phone:915-587-9455
Practice Address - Fax:915-581-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184534901Medicaid
TX184534901Medicaid