MEDICARE: MICHELLE SIVOLOB

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	363L00000X	Nurse Practitioner	1232148	TX

General Provider Information

NPI Number	:	1164368718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SIVOLOB

Provider Business Mailing Address
First Line	:	2707 COLE AVE APT 107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1027
Country	:	US
Telephone Number	:	832-289-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 COLE AVE APT 107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1027
Country	:	US
Telephone Number	:	832-289-1512
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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Directions to “ MICHELLE SIVOLOB ” Practice Location

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