Provider Demographics
NPI:1447259809
Name:DENNIS, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M. DAVID
Other - Middle Name:
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9150 HUEBNER RD STE 290
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1598
Mailing Address - Country:US
Mailing Address - Phone:210-614-6432
Mailing Address - Fax:210-615-3577
Practice Address - Street 1:9150 HUEBNER RD STE 290
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1598
Practice Address - Country:US
Practice Address - Phone:210-614-6432
Practice Address - Fax:210-615-3577
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4294207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115447802Medicaid
TX89J505Medicare PIN
TX115447802Medicaid
TXC15182Medicare UPIN