MEDICARE: MICHAEL CONRAD DENNIS M.D.

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	2084P0800X	Psychiatry Physician	E-10636	AR

General Provider Information

NPI Number	:	1548603764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CONRAD DENNIS M.D.

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4393
Country	:	US
Telephone Number	:	501-812-7215
Fax Number	:	501-202-7006

Provider Business Practice Location Address
First Line	:	11321 INTERSTATE 30 STE 304
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7067
Country	:	US
Telephone Number	:	501-487-6010
Fax Number	:	501-202-7513

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

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	07/20/2021

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