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General NPI Number Information
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NPI Number | 1427585900
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Entity Type | Organization
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Legal Business Name | MPM PROFESSIONAL LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 17331 IH 35 N STE 103
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City | SCHERTZ
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State | TX
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Zip | 78154-1273
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Country | US
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Telephone | 210-774-5061
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Fax |
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Provider Business Mailing Address
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Address Line | 7603 BRAUN BND
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City | SAN ANTONIO
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State | TX
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Zip | 78250-2603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MICHAEL MCLEOD
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Credential | MD
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Telephone | 210-774-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | P7159
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | P7159
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License Number State | TX
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