Provider Demographics
NPI:1275805749
Name:MICHAEL RABORN MD PA
Entity Type:Organization
Organization Name:MICHAEL RABORN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RABORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-275-6436
Mailing Address - Street 1:2239 S CARAWAY RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6204
Mailing Address - Country:US
Mailing Address - Phone:870-275-6436
Mailing Address - Fax:
Practice Address - Street 1:2239 S CARAWAY RD
Practice Address - Street 2:SUITE N
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6204
Practice Address - Country:US
Practice Address - Phone:870-275-6436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty