Provider Demographics
NPI:1598806192
Name:NORTH, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:NORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3130 E RACE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4991
Mailing Address - Country:US
Mailing Address - Phone:501-268-3232
Mailing Address - Fax:501-268-7327
Practice Address - Street 1:3130 E RACE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4991
Practice Address - Country:US
Practice Address - Phone:501-268-3232
Practice Address - Fax:501-268-7327
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2020-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO112253207Q00000X
ARE0593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208727115Medicaid
AR129905001Medicaid
MO98626OtherAR BLUE SHIELD #
AR129905001Medicaid
MO211013268Medicare PIN