Provider Demographics
NPI:1699726141
Name:NOSS, MICHAEL R (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:NOSS
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 1:9304 FOREST LN STE 161N
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6238
Mailing Address - Country:US
Mailing Address - Phone:214-342-5800
Mailing Address - Fax:
Practice Address - Street 1:5300 UNIVERSITY HILLS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-1219
Practice Address - Country:US
Practice Address - Phone:214-941-3500
Practice Address - Fax:214-389-1084
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH06952084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132292710Medicaid
TX132292709Medicaid
TX132292713Medicaid
TX8K4031OtherBLUE CROSS BLUE SHIELD
TX132292712Medicaid
TXA67455Medicare UPIN
TX132292710Medicaid