Healthcare Provider Details

I. General information

NPI: 1821258559
Provider Name (Legal Business Name): MICHAEL SEAN PATZKOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR MCHE-QD (CREDS)
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

3851 ROGER BROOKE DR MCHE-QD (CREDS)
FORT SAM HOUSTON TX
78234-4501
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-2118
  • Fax:
Mailing address:
  • Phone: 210-916-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101246468
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: