Healthcare Provider Details

I. General information

NPI: 1093924391
Provider Name (Legal Business Name): MICHAEL T SOLOMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL T HAILEMARIAM M.D.

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

IV. Provider business mailing address

2100 SOUTHBRIDGE PKWY STE 650
BIRMINGHAM AL
35209-1317
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-3311
  • Fax: 404-666-7390
Mailing address:
  • Phone: 205-737-0307
  • Fax: 404-666-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number34547
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number2024038194
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024038194
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34547
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number2024038194
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: