Provider Demographics
NPI:1679562094
Name:ALBERT, MICHAEL HOLGER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOLGER
Last Name:ALBERT
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 1:129 CENTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-4800
Mailing Address - Country:US
Mailing Address - Phone:769-233-7141
Mailing Address - Fax:769-233-7726
Practice Address - Street 1:129 CENTER ST STE B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-4800
Practice Address - Country:US
Practice Address - Phone:692-337-1417
Practice Address - Fax:769-233-7726
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018403Medicaid
1679562094OtherNPI
MS080000359Medicare PIN
MS080012177Medicare Oscar/Certification
MSB30693Medicare UPIN
080004283Medicare PIN