Healthcare Provider Details

I. General information

NPI: 1225110232
Provider Name (Legal Business Name): MICHAEL DONOVAN MCHANN OPA-C, LSA,CST/CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6314 ST PLACIDIA DR
SPRING TX
77379-2640
US

IV. Provider business mailing address

6314 ST PLACIDIA DR
SPRING TX
77379-2640
US

V. Phone/Fax

Practice location:
  • Phone: 281-414-3409
  • Fax:
Mailing address:
  • Phone: 281-414-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberSA00046
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: