Basic Information
Provider Information
NPI: 1942259247
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANES
FirstName: MICHELLE
MiddleName: AILEEN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11511 SHADOW CREEK PKWY
Address2:  
City: PEARLAND
State: TX
PostalCode: 775847298
CountryCode: US
TelephoneNumber: 7134420000
FaxNumber:  
Practice Location
Address1: 17198 ST LUKES WAY
Address2: SUITE 540
City: THE WOODLANDS
State: TX
PostalCode: 773848011
CountryCode: US
TelephoneNumber: 7134421900
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/06/2006
LastUpdateDate: 06/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XM1128TXY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

ID Information
IDTypeStateIssuerDescription
17651170305TX MEDICAID
17651170405TX MEDICAID


Home