Provider Demographics
NPI:1497756670
Name:FLANAGAN, MICHAEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:O
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1103
Mailing Address - Country:US
Mailing Address - Phone:505-884-1700
Mailing Address - Fax:505-884-0510
Practice Address - Street 1:4209 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1103
Practice Address - Country:US
Practice Address - Phone:505-884-1700
Practice Address - Fax:505-884-0510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-1762084A0401X, 2084N0600X, 2084P0005X, 2084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Not Answered2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF7519Medicaid
F39957Medicare UPIN