MEDICARE: MICHAEL JOSEPH REARDON 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	F1925	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01074938	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8W8515	OTHER	TX	BLUE CROSS BLUE SHIELD
3	8W8515	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174523229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH REARDON MD

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	STE 1401
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-5200
Fax Number	:	713-793-7428

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 1401
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-5200
Fax Number	:	713-793-7428

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/23/2016

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Directions to “ MICHAEL JOSEPH REARDON MD” Practice Location

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