Healthcare Provider Details

I. General information

NPI: 1881429876
Provider Name (Legal Business Name): MICHAEL ANDREW CAISSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E CLIFF DR # B
EL PASO TX
79902-4850
US

IV. Provider business mailing address

2040 PUEBLO NUEVO CIR
EL PASO TX
79936-3712
US

V. Phone/Fax

Practice location:
  • Phone: 915-313-3002
  • Fax:
Mailing address:
  • Phone: 915-241-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: