Provider Demographics
NPI:1902917107
Name:FOOT CARE ASSOCIATES OF TEXAS PA
Entity Type:Organization
Organization Name:FOOT CARE ASSOCIATES OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HANLON
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-540-1444
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-540-1444
Mailing Address - Fax:281-432-5865
Practice Address - Street 1:23972A HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1535
Practice Address - Country:US
Practice Address - Phone:281-540-1444
Practice Address - Fax:281-446-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0780213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112230102Medicaid
TXOOT57KMedicare PIN
TX112230102Medicaid