Healthcare Provider Details

I. General information

NPI: 1760061709
Provider Name (Legal Business Name): MICHAEL JOSEPH RADCLIFFE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 RED OAK DR STE 102
HOUSTON TX
77090-2611
US

IV. Provider business mailing address

17215 RED OAK DR STE 102
HOUSTON TX
77090-2611
US

V. Phone/Fax

Practice location:
  • Phone: 281-444-4114
  • Fax:
Mailing address:
  • Phone: 281-444-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number692224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: