MEDICARE: MICHAEL E CLEVENGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	J8964	TX
2	2084N0400X	Neurology Physician	E4264	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245230341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E CLEVENGER MD

Provider Business Mailing Address
First Line	:	2900 HAWKINS DR
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4802
Country	:	US
Telephone Number	:	501-278-2800
Fax Number	:	501-278-3073

Provider Business Practice Location Address
First Line	:	2900 HAWKINS DR
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-4802
Country	:	US
Telephone Number	:	501-278-2800
Fax Number	:	501-278-3073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	04/02/2020

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Directions to “ MICHAEL E CLEVENGER MD” Practice Location

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