MEDICARE: DR. MICHAEL GLENN HIGHTOWER PH.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	103G00000X	Clinical Neuropsychologist	22869	TX

General Provider Information

NPI Number	:	1700101433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GLENN HIGHTOWER PH.D.

Provider Business Mailing Address
First Line	:	6 LUCAS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3407
Country	:	US
Telephone Number	:	817-721-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 LUCAS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3407
Country	:	US
Telephone Number	:	817-721-1319
Fax Number	:

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

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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