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General NPI Number Information
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NPI Number | 1164658100
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Entity Type | Organization
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Legal Business Name | MICHELE BLACKWELL MD PA
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 450 MEDICAL CENTER BLVD STE 540
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City | WEBSTER
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State | TX
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Zip | 77598-4232
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Country | US
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Telephone | 832-932-5138
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Fax | 832-932-5142
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Provider Business Mailing Address
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Address Line | 450 MEDICAL CENTER BLVD STE 540
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City | WEBSTER
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State | TX
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Zip | 77598-4232
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Country | US
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Telephone | 832-932-5138
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Fax | 932-932-5142
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHELE M BLACKWELL
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Credential | MD
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Telephone | 832-932-5138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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