MEDICARE: DR. MICHAEL POOL COSELLI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G4933	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033128988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL POOL COSELLI M.D.

Provider Business Mailing Address
First Line	:	6560 FANNIN ST
Second Line	:	STE 1608
City	:	HOUSTON
State	:	TX
Zip	:	77030-2736
Country	:	US
Telephone Number	:	713-796-1608
Fax Number	:	713-796-1620

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST
Second Line	:	STE 1608
City	:	HOUSTON
State	:	TX
Zip	:	77030-2736
Country	:	US
Telephone Number	:	713-796-1608
Fax Number	:	713-796-1620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/06/2010

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