Provider Demographics
NPI:1285938449
Name:MUSALLAM, MICHELLE SAMIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SAMIA
Last Name:MUSALLAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7629
Mailing Address - Country:US
Mailing Address - Phone:923-523-6151
Mailing Address - Fax:
Practice Address - Street 1:311 N ALLEN DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2539
Practice Address - Country:US
Practice Address - Phone:972-727-8000
Practice Address - Fax:972-727-0842
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03008363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX421003YKP5Medicare PIN