Healthcare Provider Details

I. General information

NPI: 1972122489
Provider Name (Legal Business Name): MICHELLE PLOCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN STREET SUITE MSB 1.134
HOUSTON TX
77030
US

IV. Provider business mailing address

6431 FANNIN STREET SUITE MSB 1.134
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-6500
  • Fax: 713-500-6497
Mailing address:
  • Phone: 713-500-6500
  • Fax: 713-500-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: