=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912926197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL S. SWEENEY, M.D., PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 10/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 FANNIN ST SUITE 1824
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-521-2825
-----------------------------------------------------
Fax | 713-521-0397
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6560 FANNIN ST SUITE 1824
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-521-2825
-----------------------------------------------------
Fax | 713-521-0397
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL S SWEENEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-521-2825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | E6180
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------