MEDICARE: MR. MICHAEL EDWIN SAMUEL NACOL MD

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	207R00000X	Internal Medicine Physician	F6987	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114915030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EDWIN SAMUEL NACOL MD

Provider Business Mailing Address
First Line	:	3201 S AUSTIN AVE
Second Line	:	130
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-7537
Country	:	US
Telephone Number	:	512-863-7440
Fax Number	:	512-869-8716

Provider Business Practice Location Address
First Line	:	3201 S AUSTIN AVE
Second Line	:	130
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-7537
Country	:	US
Telephone Number	:	512-863-7440
Fax Number	:	512-869-8716

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	01/08/2010

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