Healthcare Provider Details

I. General information

NPI: 1699726141
Provider Name (Legal Business Name): MICHAEL R. NOSS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 UNIVERSITY HILLS BLVD
DALLAS TX
75241-1219
US

IV. Provider business mailing address

9304 FOREST LN STE 161N
DALLAS TX
75243-6238
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-3500
  • Fax: 214-389-1084
Mailing address:
  • Phone: 214-342-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberH0695
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH0695
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: