| Mina Michael LLC | |
|
1355 Dave Ward Dr Ste 102 Conway AR 72034-7082 | |
| (346) 907-4805 | |
| Not Available |
| Full Name | Mina Michael LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1355 Dave Ward Dr Ste 102, Conway, Arkansas |
| Authorized Official Name and Position | Mina Michael Kamel Michael (OWNER OF ENTITY) |
| Authorized Official Contact | 3469074805 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mina Michael LLC Po Box 242198 Little Rock AR 72223-0021 Ph: (346) 907-4805 | Mina Michael LLC 1355 Dave Ward Dr Ste 102 Conway AR 72034-7082 Ph: (346) 907-4805 |
| NPI Number | 1912789835 |
|---|---|
| Provider Enumeration Date | 10/16/2023 |
| Last Update Date | 05/06/2024 |
| Certification Date | 05/06/2024 |
| Medicare PECOS PAC ID | 4284082702 |
|---|---|
| Medicare Enrollment ID | O20231122000628 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912789835 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Mina Michael |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124687157 PECOS PAC ID: 1850779224 Enrollment ID: I20220718002524 |
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