MEDICARE: MICHELLE CUMMINS 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	207Y00000X	Otolaryngology Physician	K9250	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0016EJ	OTHER	TX	BCBS OF TX #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	74-2951453	OTHER	TX	TAX ID #

General Provider Information

NPI Number	:	1811972185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CUMMINS MD

Provider Business Mailing Address
First Line	:	PO BOX 5511
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-5511
Country	:	US
Telephone Number	:	361-551-2565
Fax Number	:	361-551-2568

Provider Business Practice Location Address
First Line	:	1300 N VIRGINIA ST
Second Line	:	SUITE 112
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-2516
Country	:	US
Telephone Number	:	361-551-2565
Fax Number	:	361-551-2568

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	06/12/2009

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Directions to “ MICHELLE CUMMINS MD” Practice Location

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