Healthcare Provider Details

I. General information

NPI: 1992844989
Provider Name (Legal Business Name): ADRIAN A MICHAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 TIERRA DE MESILLA
LA MESILLA NM
88046
US

IV. Provider business mailing address

PO BOX 1268
MESILLA NM
88046-1268
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-9189
  • Fax: 575-652-4064
Mailing address:
  • Phone: 575-526-9189
  • Fax: 575-652-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004-0251
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD2006-0771
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2006-0771
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberN8041
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: