MEDICARE: MICHAEL R. NOSS DO

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	2084P0802X	Addiction Psychiatry Physician	H0695	TX
2	2084P0800X	Psychiatry Physician	H0695	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8K4031	OTHER	TX	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699726141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R. NOSS DO

Provider Business Mailing Address
First Line	:	9304 FOREST LN STE 161N
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-6238
Country	:	US
Telephone Number	:	214-342-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 UNIVERSITY HILLS BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-1219
Country	:	US
Telephone Number	:	214-941-3500
Fax Number	:	214-389-1084

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/23/2023

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Directions to “ MICHAEL R. NOSS DO” Practice Location

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