MEDICARE: DR. MICHELLE NGUYEN MANEEVESE 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	2085R0204X	Vascular & Interventional Radiology Physician	S2836	TX
2	2085R0202X	Diagnostic Radiology Physician	S2836	TX
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1487073474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE NGUYEN MANEEVESE MD

Provider Business Mailing Address
First Line	:	5151 KATY FWY STE 170
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2261
Country	:	US
Telephone Number	:	713-703-2349
Fax Number	:	833-906-2508

Provider Business Practice Location Address
First Line	:	5151 KATY FWY STE 170
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2261
Country	:	US
Telephone Number	:	713-703-2349
Fax Number	:	346-509-4575

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

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	06/27/2022

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