Provider Demographics
NPI:1255477311
Name:MORRIS, MICHAEL KENNETH (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENNETH
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W MEIGHAN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-3210
Mailing Address - Country:US
Mailing Address - Phone:256-547-6522
Mailing Address - Fax:256-543-7477
Practice Address - Street 1:200 W MEIGHAN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3210
Practice Address - Country:US
Practice Address - Phone:256-547-6522
Practice Address - Fax:256-543-7477
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO750208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H69493Medicare UPIN