Healthcare Provider Details

I. General information

NPI: 1508808551
Provider Name (Legal Business Name): MICHAEL G DOUGLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ASHELAND AVE
ASHEVILLE NC
28801-4016
US

IV. Provider business mailing address

PO BOX 1987
INDIANAPOLIS IN
46206-1987
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-9090
  • Fax: 828-213-9091
Mailing address:
  • Phone: 877-685-2164
  • Fax: 317-705-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9700931
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number9700931
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: