Provider Demographics
NPI:1043249717
Name:MIGUEL, BRENO LOUREIRO (MD)
Entity type:Individual
Prefix:
First Name:BRENO
Middle Name:LOUREIRO
Last Name:MIGUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6031 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4209
Mailing Address - Country:US
Mailing Address - Phone:713-694-6600
Mailing Address - Fax:713-694-6616
Practice Address - Street 1:6031 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4209
Practice Address - Country:US
Practice Address - Phone:713-694-6600
Practice Address - Fax:713-694-6616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5466207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154174001Medicaid
TX154174002Medicaid
TX154174003Medicaid
00713UMedicare PIN
TX154174002Medicaid
TX154174001Medicaid
TXH71929Medicare UPIN