Healthcare Provider Details

I. General information

NPI: 1962951046
Provider Name (Legal Business Name): MICHAEL EWAH BSRRT.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13507 S PEACHFIELD CIR
HOUSTON TX
77014-2012
US

IV. Provider business mailing address

13507 S PEACHFIELD CIR
HOUSTON TX
77014-2012
US

V. Phone/Fax

Practice location:
  • Phone: 713-471-3277
  • Fax: 281-580-4811
Mailing address:
  • Phone: 713-471-3277
  • Fax: 281-580-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number50799
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: