Healthcare Provider Details

I. General information

NPI: 1043743800
Provider Name (Legal Business Name): MICHAEL BIRAU DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2017
Last Update Date: 03/13/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N BELT LINE RD STE A
MESQUITE TX
75149-1791
US

IV. Provider business mailing address

8135 FOREST LN # 515057
DALLAS TX
75230-2472
US

V. Phone/Fax

Practice location:
  • Phone: 972-288-7441
  • Fax: 833-916-2197
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number3074
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: