Provider Demographics
NPI:1164474722
Name:SHEWMAKE, KRISTOPHER B (MD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:B
Last Name:SHEWMAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:B
Other - Last Name:SHEWMAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-6562
Practice Address - Street 1:9500 KANIS ROAD
Practice Address - Street 2:STE 501
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-219-8388
Practice Address - Fax:501-217-2520
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6666208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111463001Medicaid
AR111463001Medicaid