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NPI Code Detail

MEDICARE: MICHEAL REDDELL PA

MEDICARE: MICHEAL REDDELL PA
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
1363A00000XPhysician AssistantPA04637TX

General Provider Information

NPI Number : 1356329387
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHEAL REDDELL PA
Provider Business Mailing Address
First Line : 301 UTICA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3111
Country : US
Telephone Number : 806-797-4985
Fax Number : 806-792-8588
Provider Business Practice Location Address
First Line : 301 UTICA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3111
Country : US
Telephone Number : 806-797-4985
Fax Number : 806-792-8588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 01/20/2025

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Directions to “ MICHEAL REDDELL PA” Practice Location

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