Healthcare Provider Details

I. General information

NPI: 1164834891
Provider Name (Legal Business Name): MICHELLE PIKE - HOUGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 PETER BRYCE BLVD
TUSCALOOSA AL
35401-7419
US

IV. Provider business mailing address

850 PETER BRYCE BLVD
TUSCALOOSA AL
35401-7419
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-1770
  • Fax: 205-348-6561
Mailing address:
  • Phone: 205-348-1770
  • Fax: 205-348-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL4029R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: