MEDICARE: MICHAEL TREVOR HOUSEAL PA-C

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	363AS0400X	Surgical Physician Assistant	3903	TN

General Provider Information

NPI Number	:	1518519057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TREVOR HOUSEAL PA-C

Provider Business Mailing Address
First Line	:	PO BOX 22403
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4476
Country	:	US
Telephone Number	:	888-402-7256
Fax Number	:	888-902-1099

Provider Business Practice Location Address
First Line	:	6005 PARK AVE STE 802
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5218
Country	:	US
Telephone Number	:	901-236-0508
Fax Number	:	901-682-2143

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

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	07/24/2025

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