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NPI Code Detail

MEDICARE: MICHAEL WAYNE VERMEULEN PA

MEDICARE: MICHAEL WAYNE VERMEULEN PA
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
1363AM0700XMedical Physician AssistantPA04518TX
2363A00000XPhysician AssistantPA04518TX

Other Identifiers

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

General Provider Information

NPI Number : 1407829872
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WAYNE VERMEULEN PA
Provider Business Mailing Address
First Line : PO BOX 911230
Second Line :
City : DALLAS
State : TX
Zip : 75391-1230
Country : US
Telephone Number : 210-595-5300
Fax Number : 210-595-5301
Provider Business Practice Location Address
First Line : 5206 RESEARCH DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78240-5251
Country : US
Telephone Number : 210-595-5300
Fax Number : 210-614-8740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 07/27/2022

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Directions to “ MICHAEL WAYNE VERMEULEN PA” Practice Location

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