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General NPI Number Information
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NPI Number | 1912789835
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Entity Type | Organization
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Legal Business Name | MINA MICHAEL LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1355 DAVE WARD DR STE 102
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City | CONWAY
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State | AR
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Zip | 72034-7082
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Country | US
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Telephone | 346-907-4805
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 242198
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City | LITTLE ROCK
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State | AR
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Zip | 72223-0021
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Country | US
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Telephone | 346-907-4805
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Fax |
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | MINA MICHAEL KAMEL MICHAEL
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Credential | MD
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Telephone | 346-907-4805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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