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General NPI Number Information
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NPI Number | 1619946324
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Entity Type | Organization
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Legal Business Name | MICHEL STEPHAN MD PA
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 2540 N GALLOWAY AVE #101
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City | MESQUITE
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State | TX
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Zip | 75150-6306
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Country | US
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Telephone | 972-226-0405
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Fax | 972-270-4959
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Provider Business Mailing Address
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Address Line | 2540 NTH GALLOWAY AVENUE #101
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City | MESQUITE
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State | TX
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Zip | 75150
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Country | US
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Telephone | 972-226-0405
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Fax | 972-270-4959
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHEL KHAMIS STEPHAN
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Credential | M D
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Telephone | 972-226-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | F8687
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License Number State | TX
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