Individual
DR. MICHAEL EDWARD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 GASTON AVE, WADLEY TOWER, SUITE 261, DALLAS, TX 75246-1800
(214) 823-6492
(214) 818-9180
Mailing address
3600 GASTON AVE, BARNETT TOWER, SUITE 707, DALLAS, TX 75246-1800
(214) 823-6492
(214) 818-9180
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
K1979
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042638901
—
TX
01
—
83P753
BLUE CROSS BLUE SHIELD
TX
01
—
P00128419
RAILROAD MEDICARE
TX
Enumeration date
06/30/2006
Last updated
07/27/2010
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