Provider Demographics
NPI:1346862703
Name:MIKE C. UMERAH, M.D. INC.
Entity Type:Organization
Organization Name:MIKE C. UMERAH, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:UMERAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-664-2991
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 705
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5372
Mailing Address - Country:US
Mailing Address - Phone:501-664-2991
Mailing Address - Fax:501-664-7111
Practice Address - Street 1:500 S UNIVERSITY AVE STE 705
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5372
Practice Address - Country:US
Practice Address - Phone:501-664-2991
Practice Address - Fax:501-664-7111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIKE C. UMERAH, M.D. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158107001Medicaid