Healthcare Provider Details

I. General information

NPI: 1023674231
Provider Name (Legal Business Name): MICHAEL MGERIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 KATY FWY STE 200
HOUSTON TX
77024-1629
US

IV. Provider business mailing address

12141 RICHMOND AVE
HOUSTON TX
77082-2408
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 281-588-8341
  • Fax: 281-295-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT3824
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: