MEDICARE: DR. MICHELLE KREISBERG HORTON 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
1	207ZC0500X	Cytopathology Physician	Q1172	TX
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	003706	GA
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	Q1172	TX

General Provider Information

NPI Number	:	1699903294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE KREISBERG HORTON D.O.

Provider Business Mailing Address
First Line	:	PO BOX 2386
Second Line	:	THYROID CYTOPATHOLOGY PARTNERS
City	:	ROUND ROCK
State	:	GA
Zip	:	78664
Country	:	US
Telephone Number	:	706-836-7397
Fax Number	:	512-597-2713

Provider Business Practice Location Address
First Line	:	12357 A RIATA TRACE PKWY, BLDG 5, STE 100
Second Line	:	THYROID CYTOPATHOLOGY PARTNERS
City	:	AUSTIN
State	:	TX
Zip	:	78727
Country	:	US
Telephone Number	:	512-814-0298
Fax Number	:	512-597-2713

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

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	11/04/2014

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