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General NPI Number Information
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NPI Number | 1962366237
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Entity Type | Individual
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Provider Name | MR. MICHAEL ROBERT PARK
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Gender | Male
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 8215 UNIVERSITY AVE STE 100
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City | LUBBOCK
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State | TX
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Zip | 79423-3169
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Country | US
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Telephone | 806-698-1083
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Fax |
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Provider Business Mailing Address
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Address Line | 10100 E PR 5150
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City | PETERSBURG
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State | TX
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Zip | 79250
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Country | US
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Telephone | 806-777-2695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 81194
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License Number State | TX
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