Healthcare Provider Details

I. General information

NPI: 1972877785
Provider Name (Legal Business Name): MICHELLE LYNN ALIOTTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 N NEW BRAUNFELS AVE
SAN ANTONIO TX
78209-3827
US

IV. Provider business mailing address

8711 VILLAGE DR STE 114
SAN ANTONIO TX
78217-5419
US

V. Phone/Fax

Practice location:
  • Phone: 210-824-5392
  • Fax: 210-824-3986
Mailing address:
  • Phone: 210-824-5392
  • Fax: 210-824-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP3501
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: