Organization
MPM PROFESSIONAL LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MCLEOD MD (PRESIDENT/CEO)
(210) 774-5061
Entity
Organization
Contact information
Practice address
17331 IH 35 N STE 103, SCHERTZ, TX 78154-1273
(210) 774-5061
Mailing address
7603 BRAUN BND, SAN ANTONIO, TX 78250-2603
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
P7159
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
P7159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29430YWSL
MEDICARE
—
Enumeration date
05/16/2017
Last updated
10/25/2018
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