Provider Demographics
NPI:1659391548
Name:WOOD, MICHAEL N (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:WOOD
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 1:1622 SIBERT DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35905-9687
Mailing Address - Country:US
Mailing Address - Phone:909-908-1361
Mailing Address - Fax:909-494-5576
Practice Address - Street 1:405 S 1ST ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5358
Practice Address - Country:US
Practice Address - Phone:256-279-8738
Practice Address - Fax:256-963-9987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58175208G00000X
AL73534208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659391548Medicaid
1659391548OtherNPI
VA1659391548Medicaid