Provider Demographics
NPI:1245419811
Name:MICHAEL S MISHKIN MD PC
Entity Type:Organization
Organization Name:MICHAEL S MISHKIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-437-5716
Mailing Address - Street 1:1315 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5810
Mailing Address - Country:US
Mailing Address - Phone:575-437-5716
Mailing Address - Fax:
Practice Address - Street 1:1315 12TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5810
Practice Address - Country:US
Practice Address - Phone:575-437-5716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93337207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty