MEDICARE: MICHELLE C SCANLAN MD

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	207R00000X	Internal Medicine Physician	K3936	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110231816	OTHER		RAILROAD MEDICARE

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	:	1275534109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE C SCANLAN MD

Provider Business Mailing Address
First Line	:	4410 MEDICAL DR
Second Line	:	STE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6306
Country	:	US
Telephone Number	:	210-614-4000
Fax Number	:	210-614-9114

Provider Business Practice Location Address
First Line	:	4410 MEDICAL DR
Second Line	:	STE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6306
Country	:	US
Telephone Number	:	210-614-4000
Fax Number	:	210-614-9114

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/23/2009

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Directions to “ MICHELLE C SCANLAN MD” Practice Location

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