Healthcare Provider Details

I. General information

NPI: 1497240295
Provider Name (Legal Business Name): MICHELINA ROSA IPPOLITI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELINA ROSA IPPOLITI DI MAURO

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SW 36TH ST
SAN ANTONIO TX
78237-3360
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-5100
  • Fax: 210-358-5157
Mailing address:
  • Phone: 713-442-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS8717
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: