Healthcare Provider Details

I. General information

NPI: 1558314336
Provider Name (Legal Business Name): MICHAEL STEVEN PUHL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 CIRCLEVIEW DR
WEATHERFORD TX
76087-9158
US

IV. Provider business mailing address

6344 DAVIS BLVD
N RICHLAND HILLS TX
76180-4762
US

V. Phone/Fax

Practice location:
  • Phone: 817-598-0534
  • Fax:
Mailing address:
  • Phone: 817-849-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number649401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: