Provider Demographics
NPI:1154345593
Name:STAVINOHA, MICHAEL W (MD PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:STAVINOHA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 NORTH LOOP WEST
Mailing Address - Street 2:SUITE 655
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1599
Mailing Address - Country:US
Mailing Address - Phone:713-869-8200
Mailing Address - Fax:713-867-2013
Practice Address - Street 1:1631 NORTH LOOP WEST
Practice Address - Street 2:SUITE 655
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1599
Practice Address - Country:US
Practice Address - Phone:713-869-8200
Practice Address - Fax:713-867-2013
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8436207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127858203Medicaid
TXOOB95UMedicare ID - Type Unspecified
TX127858203Medicaid