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NPI Code Detail

MEDICARE: DR. LUIS G SAN MIGUEL D.O.

MEDICARE: DR. LUIS G SAN MIGUEL D.O.
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
1208M00000XHospitalist PhysicianK5201TX
2207Q00000XFamily Medicine PhysicianK5201TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TXB145154OTHERTXWELLMED MEDICAL GROUP PA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508830985
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUIS G SAN MIGUEL D.O.
Provider Business Mailing Address
First Line : PO BOX 3046
Second Line :
City : MALVERN
State : PA
Zip : 19355-0746
Country : US
Telephone Number : 956-632-4000
Fax Number : 956-961-4286
Provider Business Practice Location Address
First Line : 301 W EXPRESSWAY 83
Second Line :
City : MCALLEN
State : TX
Zip : 78503-3045
Country : US
Telephone Number : 956-632-4000
Fax Number : 956-961-4286
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 03/17/2018

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