Healthcare Provider Details

I. General information

NPI: 1801849385
Provider Name (Legal Business Name): MICHAEL T MINEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 2030
HOUSTON TX
77030-2727
US

IV. Provider business mailing address

PO BOX 1400
HOUSTON TX
77251-1400
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-9779
  • Fax: 713-794-0719
Mailing address:
  • Phone: 713-351-0644
  • Fax: 713-351-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberL5056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: