MEDICARE: MR. MICHAEL LEO ASHLEY C. PED

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	224L00000X	Pedorthist

General Provider Information

NPI Number	:	1194239517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LEO ASHLEY C. PED

Provider Business Mailing Address
First Line	:	3301 GLENSHIRE DR APT 3202
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-5226
Country	:	US
Telephone Number	:	214-702-8812
Fax Number	:	214-291-9576

Provider Business Practice Location Address
First Line	:	3301 GLENSHIRE DR APT 3202
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75180-5226
Country	:	US
Telephone Number	:	214-702-8812
Fax Number	:	214-291-9576

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

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	11/21/2017

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