MEDICARE: MICAELA DARTSON DPM

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	213E00000X	Podiatrist	1306	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00606710	OTHER	TX	RAILROAD MEDICARE

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	0011AW	OTHER	TX	BLUE SHIELD

General Provider Information

NPI Number	:	1760565329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAELA DARTSON DPM

Provider Business Mailing Address
First Line	:	2500 MAYWOOD LN
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-4393
Country	:	US
Telephone Number	:	214-725-9663
Fax Number	:	972-548-1079

Provider Business Practice Location Address
First Line	:	4101 MCEWEN RD
Second Line	:	STE 625
City	:	DALLAS
State	:	TX
Zip	:	75244-5112
Country	:	US
Telephone Number	:	214-221-9116
Fax Number	:	214-219-1120

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/11/2017

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Directions to “ MICAELA DARTSON DPM” Practice Location

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