MEDICARE: MS. MICHELLE MARTIN

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	363A00000X	Physician Assistant	PA09277	TX

General Provider Information

NPI Number	:	1063823383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE MARTIN

Provider Business Mailing Address
First Line	:	4107 MEDICAL PKWY STE 210
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3738
Country	:	US
Telephone Number	:	512-323-5465
Fax Number	:

Provider Business Practice Location Address
First Line	:	4107 MEDICAL PKWY STE 210
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3738
Country	:	US
Telephone Number	:	512-323-5465
Fax Number	:	512-327-1390

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

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	07/21/2022

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Directions to “ MS. MICHELLE MARTIN ” Practice Location

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