Healthcare Provider Details

I. General information

NPI: 1881445104
Provider Name (Legal Business Name): MICHAEL DEA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555
US

IV. Provider business mailing address

THE UNIVERSITY OF TEXAS MEDICAL BRANCH 301 UNIVERSITY BLVD
GALVESTON TX
77555
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8652
  • Fax:
Mailing address:
  • Phone: 409-266-7856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: