Provider Demographics
NPI:1174381792
Name:CHRISTOPHER J MICALLEF DO PLLC
Entity type:Organization
Organization Name:CHRISTOPHER J MICALLEF DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MICALLEF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-830-4249
Mailing Address - Street 1:7600 BROADWAY APT 4008
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1980
Mailing Address - Country:US
Mailing Address - Phone:937-830-4249
Mailing Address - Fax:210-547-0265
Practice Address - Street 1:4372 N LOOP 1604 W STE 200
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-1201
Practice Address - Country:US
Practice Address - Phone:726-206-3484
Practice Address - Fax:210-547-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty