Healthcare Provider Details

I. General information

NPI: 1952862955
Provider Name (Legal Business Name): KARL MIGACZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ROCKMEAD DR STE 600
KINGWOOD TX
77339-2259
US

IV. Provider business mailing address

611 ROCKMEAD DR STE 600
KINGWOOD TX
77339-2259
US

V. Phone/Fax

Practice location:
  • Phone: 281-348-7575
  • Fax:
Mailing address:
  • Phone: 832-828-2626
  • Fax: 832-825-9538

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 Code208000000X
TaxonomyPediatrics Physician
License NumberT5397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: