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General NPI Number Information
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NPI Number | 1134169048
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Entity Type | Individual
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Provider Name | MICHAEL A BADEJO PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 403 W MAIN ST SUITE B
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City | LEWISVILLE
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State | TX
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Zip | 75057-3757
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Country | US
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Telephone | 972-436-1811
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Fax | 469-464-4398
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Provider Business Mailing Address
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Address Line | 403 W MAIN ST SUITE B
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City | LEWISVILLE
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State | TX
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Zip | 75057-3757
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Country | US
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Telephone | 972-436-1811
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Fax | 469-464-4398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA04564
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License Number State | TX
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