Provider Demographics
NPI:1164515318
Name:NOLEN, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:NOLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7 SHACKLEFORD WEST BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3714
Mailing Address - Country:US
Mailing Address - Phone:501-492-2525
Mailing Address - Fax:501-492-2528
Practice Address - Street 1:7 SHACKLEFORD WEST BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3714
Practice Address - Country:US
Practice Address - Phone:501-492-2525
Practice Address - Fax:501-492-2528
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2867208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARI06360Medicare UPIN
AR5M912Medicare ID - Type UnspecifiedMEDICARE #