Provider Demographics
NPI:1104872449
Name:MICHELSEN, STEVEN WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:MICHELSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 COIT RD.
Mailing Address - Street 2:STE. 211
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-335-8455
Mailing Address - Fax:972-335-7560
Practice Address - Street 1:4461 COIT RD.
Practice Address - Street 2:STE. 211
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-335-8455
Practice Address - Fax:972-335-7560
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7046204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH93481Medicare UPIN
TX8B2791Medicare ID - Type UnspecifiedMEDICARE NUMBER