Healthcare Provider Details

I. General information

NPI: 1619962388
Provider Name (Legal Business Name): MICHAEL HUELA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 N JIM WRIGHT FWY
WHITE SETTLEMENT TX
76108-1437
US

IV. Provider business mailing address

5716 ROCKPORT LN
HALTOM CITY TX
76137-2125
US

V. Phone/Fax

Practice location:
  • Phone: 682-703-4505
  • Fax: 682-703-4510
Mailing address:
  • Phone: 512-545-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04829
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 04829
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number04829
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: