Healthcare Provider Details

I. General information

NPI: 1215299045
Provider Name (Legal Business Name): MICHAEL E FAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HAWKINS BLVD SUITE 19
EL PASO TX
79925-2650
US

IV. Provider business mailing address

4543 POST OAK PLACE DR SUITE 125
HOUSTON TX
77027-3160
US

V. Phone/Fax

Practice location:
  • Phone: 915-633-9099
  • Fax: 915-633-8290
Mailing address:
  • Phone: 713-862-4443
  • Fax: 832-369-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80240
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: