Healthcare Provider Details

I. General information

NPI: 1700970183
Provider Name (Legal Business Name): MICHAEL HARDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE STE C12
ALBUQUERQUE NM
87102-2618
US

IV. Provider business mailing address

801 ENCINO PL NE STE C12
ALBUQUERQUE NM
87102-2618
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4849
  • Fax: 505-247-4850
Mailing address:
  • Phone: 505-247-4849
  • Fax: 505-247-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number92241
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number92-241
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: