Provider Demographics
NPI:1033195649
Name:UMERAH, MIKE C (MD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:C
Last Name:UMERAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-664-2991
Mailing Address - Fax:501-664-7111
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-664-2991
Practice Address - Fax:501-664-7111
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4217208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158107001Medicaid
ARP00322829OtherRAILROAD MEICARE
AR158107001Medicaid
I43220Medicare UPIN