Healthcare Provider Details

I. General information

NPI: 1922469147
Provider Name (Legal Business Name): MICHAEL AMIR ENGHETA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE D330
MOBILE AL
36608-6758
US

IV. Provider business mailing address

3106 HICKORY RD
TEMPLE TX
76502-1702
US

V. Phone/Fax

Practice location:
  • Phone: 251-607-9797
  • Fax: 251-607-7696
Mailing address:
  • Phone: 828-489-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS0872
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2984
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2984
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: