Provider Demographics
NPI:1265498380
Name:NOLEN, MIKE GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:GLENN
Last Name:NOLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:915 E OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6154
Mailing Address - Country:US
Mailing Address - Phone:580-237-8900
Mailing Address - Fax:580-237-4111
Practice Address - Street 1:915 E OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6156
Practice Address - Country:US
Practice Address - Phone:580-237-8900
Practice Address - Fax:580-237-4111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK16957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE28269Medicare UPIN