MEDICARE: MR. MICHAEL LEE ELLIOTT JR.

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	171M00000X	Case Manager/Care Coordinator	15313094	TX

General Provider Information

NPI Number	:	1740139575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LEE ELLIOTT JR.

Provider Business Mailing Address
First Line	:	19500 US HIGHWAY 281 N APT 618
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7508
Country	:	US
Telephone Number	:	210-663-3909
Fax Number	:

Provider Business Practice Location Address
First Line	:	19500 US HIGHWAY 281 N APT 618
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7508
Country	:	US
Telephone Number	:	210-663-3909
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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