Provider Demographics
NPI:1497240295
Name:IPPOLITI, MICHELINA ROSA (MD)
Entity type:Individual
Prefix:MISS
First Name:MICHELINA
Middle Name:ROSA
Last Name:IPPOLITI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MICHELINA
Other - Middle Name:ROSA
Other - Last Name:IPPOLITI DI MAURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-3360
Mailing Address - Country:US
Mailing Address - Phone:210-358-5100
Mailing Address - Fax:201-358-5129
Practice Address - Street 1:2121 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3360
Practice Address - Country:US
Practice Address - Phone:210-358-5100
Practice Address - Fax:210-358-5157
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8717207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine