Individual
MICHAEL MCKELVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
630 S FLEISHEL AVE, TYLER, TX 75701-2041
(903) 606-5560
Mailing address
2120 N MACARTHUR BLVD, SUITE 100, IRVING, TX 75061-2221
(972) 438-4636
(972) 438-6585
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA11152
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370509704
—
TX
Enumeration date
03/27/2017
Last updated
03/23/2021
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