Provider Demographics
NPI:1861555989
Name:MICHAEL C. PEACE, D.O.
Entity type:Organization
Organization Name:MICHAEL C. PEACE, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PEACE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-287-7187
Mailing Address - Street 1:103 E ADKINS ST
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-2801
Mailing Address - Country:US
Mailing Address - Phone:972-287-7187
Mailing Address - Fax:972-287-6493
Practice Address - Street 1:103 E ADKINS ST
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2801
Practice Address - Country:US
Practice Address - Phone:972-287-7187
Practice Address - Fax:972-287-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6504305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE39013Medicare UPIN
TX00D58JMedicare ID - Type Unspecified