Healthcare Provider Details

I. General information

NPI: 1538650072
Provider Name (Legal Business Name): MIKE THANH LE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 N MACARTHUR BLVD STE 400
IRVING TX
75038
US

IV. Provider business mailing address

3501 W HOLCOMBE BLVD
HOUSTON TX
77025-1313
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-5442
  • Fax: 844-861-1929
Mailing address:
  • Phone: 281-407-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136997
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAP136997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: