MEDICARE: MICHAEL SONG MD

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	390200000X	Student in an Organized Health Care Education/Training Program	BP10063088	TX
2	207RH0003X	Hematology & Oncology Physician	S3932	TX

General Provider Information

NPI Number	:	1699262246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SONG MD

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-3901
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-234-0813

Provider Business Practice Location Address
First Line	:	2829 BABCOCK RD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6011
Country	:	US
Telephone Number	:	210-580-9500
Fax Number	:	210-568-4397

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

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	09/04/2024

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Directions to “ MICHAEL SONG MD” Practice Location

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