Provider Demographics
NPI:1336286541
Name:MICHAEL L. PUTMAN, M.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL L. PUTMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-350-0798
Mailing Address - Street 1:PO BOX 5749
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-0749
Mailing Address - Country:US
Mailing Address - Phone:256-350-0798
Mailing Address - Fax:256-350-6466
Practice Address - Street 1:1874 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-350-0798
Practice Address - Fax:256-350-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000004302Medicaid
AL51004302OtherBCBS OF ALABAMA
AL51004302OtherBCBS OF ALABAMA
ALC73935Medicare UPIN
AL000004302Medicaid