Provider Demographics
NPI:1891174348
Name:MICHAEL WISSA, MD, PLLC
Entity type:Organization
Organization Name:MICHAEL WISSA, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:WISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-621-0640
Mailing Address - Street 1:PO BOX 782227
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-2227
Mailing Address - Country:US
Mailing Address - Phone:210-621-0640
Mailing Address - Fax:210-621-2386
Practice Address - Street 1:7940 FLOYD CURL DR
Practice Address - Street 2:#1030
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3905
Practice Address - Country:US
Practice Address - Phone:210-614-3371
Practice Address - Fax:210-621-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9935207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty