MEDICARE: PAN-AMERICAN OB-GYN 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
1	207VX0000X	Obstetrics Physician	L5466	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10004951	OTHER	TX	AMERIGROUP
2	0026JV	OTHER		BCBS

General Provider Information

NPI Number	:	1730307703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAN-AMERICAN OB-GYN PA

Provider Business Mailing Address
First Line	:	6031 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4209
Country	:	US
Telephone Number	:	713-694-6600
Fax Number	:	713-694-6616

Provider Business Practice Location Address
First Line	:	6031 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4209
Country	:	US
Telephone Number	:	713-694-6600
Fax Number	:	713-694-6616

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. BRENO LOUREIRO MIGUEL
Credential	:	MD
Telephone Number	:	713-694-6600

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	09/09/2021

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Directions to “PAN-AMERICAN OB-GYN PA ” Practice Location

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