MEDICARE: MOLLY MCMICHAEL L.AC.

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	171100000X	Acupuncturist	1266	TX

General Provider Information

NPI Number	:	1215283114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY MCMICHAEL L.AC.

Provider Business Mailing Address
First Line	:	3851 STAHL RD
Second Line	:	SUITE 123
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1686
Country	:	US
Telephone Number	:	210-298-5188
Fax Number	:	210-298-5189

Provider Business Practice Location Address
First Line	:	3851 STAHL RD
Second Line	:	SUITE 123
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1686
Country	:	US
Telephone Number	:	210-298-5188
Fax Number	:	210-298-5189

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

Provider Enumeration Date	:	07/28/2012
Last Update Date	:	07/28/2012

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Directions to “ MOLLY MCMICHAEL L.AC.” Practice Location

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