Basic Information
| Provider Information | |||||||||
| NPI: | 1003007287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GINN | ||||||||
| FirstName: | MICHAELA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14207 MEMORIAL DRIVE | ||||||||
| Address2: | #278 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135913555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13214 INDIAN CREEK ROAD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135913555 | ||||||||
| FaxNumber: | 6613213286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 77631 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 224626 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35.130643 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 67083-20 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N8098 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A111803 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4651532834 | 01 | MYUTMB 4651532834 | OTHER |