Healthcare Provider Details

I. General information

NPI: 1447230909
Provider Name (Legal Business Name): MICHAEL J MROCHEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 GEORGE DIETER DR SUITE 100
EL PASO TX
79936-7653
US

IV. Provider business mailing address

PO BOX 12793
EL PASO TX
79913-0793
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-0712
  • Fax: 915-833-7312
Mailing address:
  • Phone: 915-581-0712
  • Fax: 915-833-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ6181
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberJ6181
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: