=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548539877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILDO A MICHELETTI M.D. PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2011
-----------------------------------------------------
Last Update Date | 12/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1213 HERMANN DR STE #540
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-521-1137
-----------------------------------------------------
Fax | 713-520-9243
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1213 HERMANN STE 540
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-7089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-521-1137
-----------------------------------------------------
Fax | 713-520-9243
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GILDO A MICHELETTI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-521-1137
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | E2738
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------