Healthcare Provider Details

I. General information

NPI: 1871676403
Provider Name (Legal Business Name): MICHAEL ADOLPH OLTMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 N MEDICAL DR
STUTTGART AR
72160-3274
US

IV. Provider business mailing address

PO BOX 1901
STUTTGART AR
72160-1901
US

V. Phone/Fax

Practice location:
  • Phone: 870-673-7211
  • Fax: 870-672-6823
Mailing address:
  • Phone: 870-673-7211
  • Fax: 870-672-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL28005
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE6212
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: