Healthcare Provider Details

I. General information

NPI: 1134564891
Provider Name (Legal Business Name): MICHAEL JOSEPH LOGUIDICE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 09/08/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S SHACKLEFORD RD
LITTLE ROCK AR
72211-4335
US

IV. Provider business mailing address

1701 S SHACKLEFORD RD
LITTLE ROCK AR
72211-4335
US

V. Phone/Fax

Practice location:
  • Phone: 501-516-3993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberE-14256
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: