Individual
DR. MICHELLE BURNSIDE FOWERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 W IH 635 FWY, SUITE 250, IRVING, TX 75063-3718
(972) 481-6400
(972) 831-9794
Mailing address
400 W IH 635 FWY, SUITE 250, IRVING, TX 75063-3718
(972) 481-6400
(972) 831-9794
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L3302
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151910001
—
TX
01
—
8F3458
BCBS
TX
Enumeration date
07/08/2006
Last updated
03/31/2022
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