Provider Demographics
NPI:1528051646
Name:PAPPOLLA, MIGUEL ANGEL (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:PAPPOLLA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 S LOOP W STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2676
Mailing Address - Country:US
Mailing Address - Phone:713-661-0300
Mailing Address - Fax:281-822-0480
Practice Address - Street 1:2646 S LOOP WEST STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1901
Practice Address - Country:US
Practice Address - Phone:713-661-0300
Practice Address - Fax:281-822-0480
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ54362084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132611807Medicaid
TX132611807Medicaid
TXD91913Medicare UPIN