Individual
MICHELLE CUMMINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1300 N VIRGINIA ST, SUITE 112, PORT LAVACA, TX 77979-2516
(361) 551-2565
(361) 551-2568
Mailing address
PO BOX 5511, VICTORIA, TX 77903-5511
(361) 551-2565
(361) 551-2568
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
K9250
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016EJ
BCBS OF TX #
TX
05
—
029960401
—
TX
01
—
74-2951453
TAX ID #
TX
Enumeration date
12/09/2005
Last updated
06/12/2009
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