Provider Demographics
NPI:1447517016
Name:MEDEL, MICHELLE PHI (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PHI
Last Name:MEDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR
Mailing Address - Street 2:STE 602
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1951
Mailing Address - Country:US
Mailing Address - Phone:903-593-2468
Mailing Address - Fax:905-592-5692
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:STE 602
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-593-2468
Practice Address - Fax:905-592-5692
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6234207VX0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447517016OtherNPI