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General NPI Number Information
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NPI Number | 1821117565
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Entity Type | Organization
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Legal Business Name | ARKANSAS INTERNAL MEDICINE CLINIC PA
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE STE 605
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5308
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Country | US
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Telephone | 501-537-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE STE 605
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5308
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Country | US
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Telephone | 501-537-4590
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SOLOMON CHUKWUEMEKA MOGBO
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Credential | M.D
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Telephone | 501-537-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | EI875
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License Number State | AR
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