Healthcare Provider Details

I. General information

NPI: 1326092768
Provider Name (Legal Business Name): MICHAEL LARRY WARNEKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 ASTORIA BLVD SUITE 300
HOUSTON TX
77089-6043
US

IV. Provider business mailing address

11920 ASTORIA BLVD SUITE 300
HOUSTON TX
77089-6043
US

V. Phone/Fax

Practice location:
  • Phone: 281-481-8878
  • Fax: 281-481-9020
Mailing address:
  • Phone: 281-481-8878
  • Fax: 281-481-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF4654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: