Healthcare Provider Details

I. General information

NPI: 1639667074
Provider Name (Legal Business Name): MICHAEL AUSTIN LOESCHE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 38TH ST
AUSTIN TX
78705-1006
US

IV. Provider business mailing address

404 E WISTERIA AVE
MCALLEN TX
78504-2345
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-1000
  • Fax:
Mailing address:
  • Phone: 956-739-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT4551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: