MEDICARE: ST. MICHAEL'S PAIN AND SPINE CLINICS PLLC

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	2084N0400X	Neurology Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1710153408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MICHAEL'S PAIN AND SPINE CLINICS PLLC

Provider Business Mailing Address
First Line	:	2646 S. LOOP WEST STE 106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1901
Country	:	US
Telephone Number	:	713-661-0300
Fax Number	:	281-822-0480

Provider Business Practice Location Address
First Line	:	2646 S, LOOP WEST STE 106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1901
Country	:	US
Telephone Number	:	713-661-0300
Fax Number	:	281-822-0480

Authorized Official
Title or Position	:	OWNER
Name	:	MIGUEL ANGEL PAPPOLLA
Credential	:	MD
Telephone Number	:	713-661-0300

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	04/30/2013

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