MEDICARE: DM FRIENDLY FAMILY HEALTHCARE

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1730446493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DM FRIENDLY FAMILY HEALTHCARE

Provider Business Mailing Address
First Line	:	2301 LAUREL ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2265
Country	:	US
Telephone Number	:	281-935-1384
Fax Number	:	281-385-8518

Provider Business Practice Location Address
First Line	:	2301 LAUREL ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2265
Country	:	US
Telephone Number	:	281-935-1384
Fax Number	:	281-385-8518

Authorized Official
Title or Position	:	OWNER
Name	:	DOROTHY R MIKEL
Credential	:	RN, BSN, MSN, FNP-C
Telephone Number	:	281-935-1384

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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