Provider Demographics
NPI:1619206596
Name:STELL, MICHAEL JOE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOE
Last Name:STELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4272
Mailing Address - Country:US
Mailing Address - Phone:501-623-2488
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHRISE CIR
Practice Address - Street 2:801
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4341
Practice Address - Country:US
Practice Address - Phone:501-624-4439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
169926783Medicare PIN