Provider Demographics
NPI:1295745289
Name:ZEITLIN, MICHAEL P (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:ZEITLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926 WILLMON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1947
Mailing Address - Country:US
Mailing Address - Phone:210-379-0953
Mailing Address - Fax:210-616-9717
Practice Address - Street 1:4025 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3641
Practice Address - Country:US
Practice Address - Phone:210-333-1255
Practice Address - Fax:210-333-8496
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7262207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130772011Medicaid
TX8K1395Medicare PIN
TXTXB125412Medicare PIN
TX130772011Medicaid
TX8A2510Medicare PIN
TX0058OUMedicare PIN