MEDICARE: J MICHAEL VALENZA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	TX575	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	838463	OTHER	TX	PROVIDER #
2	00AP45	OTHER	TX	GROUP PTAN

General Provider Information

NPI Number	:	1063514362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J MICHAEL VALENZA DPM

Provider Business Mailing Address
First Line	:	5656 BEE CAVE RD
Second Line	:	STE D204
City	:	AUSTIN
State	:	TX
Zip	:	78746-5248
Country	:	US
Telephone Number	:	512-327-9251
Fax Number	:	512-327-9742

Provider Business Practice Location Address
First Line	:	5656 BEE CAVE RD
Second Line	:	STE D204
City	:	AUSTIN
State	:	TX
Zip	:	78746-5248
Country	:	US
Telephone Number	:	512-327-9251
Fax Number	:	512-327-9742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	09/19/2013

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