Mina Michael Llc | |
1355 Dave Ward Dr Ste 102 Conway AR 72034-7082 | |
(346) 907-4805 | |
Not Available |
Full Name | Mina Michael Llc |
---|---|
Speciality | Internal Medicine |
Location | 1355 Dave Ward Dr Ste 102, Conway, Arkansas |
Authorized Official Name and Position | Mina Michael Kamel Michael (OWNER OF ENTITY) |
Authorized Official Contact | 3469074805 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Mina Michael Llc Po Box 242198 Little Rock AR 72223-0021 Ph: (346) 907-4805 | Mina Michael Llc 1355 Dave Ward Dr Ste 102 Conway AR 72034-7082 Ph: (346) 907-4805 |
NPI Number | 1912789835 |
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Provider Enumeration Date | 10/16/2023 |
Last Update Date | 05/06/2024 |
Medicare PECOS PAC ID | 4284082702 |
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Medicare Enrollment ID | O20231122000628 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912789835 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Mina Michael |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1124687157 PECOS PAC ID: 1850779224 Enrollment ID: I20220718002524 |
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