Healthcare Provider Details

I. General information

NPI: 1326570219
Provider Name (Legal Business Name): BISHOY MICHAELS D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N BECKLEY AVE STE 152
DALLAS TX
75203-1586
US

IV. Provider business mailing address

11350 MCCORMICK RD EXECUTIVE PLAZA 1, SUITE 501
HUNT VALLEY MD
21031
US

V. Phone/Fax

Practice location:
  • Phone: 214-948-7700
  • Fax: 214-948-7701
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberT7654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: