Provider Demographics
NPI:1750492369
Name:PUTMAN, MICHAEL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:PUTMAN
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:PO BOX 5749
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-0749
Mailing Address - Country:US
Mailing Address - Phone:256-350-0798
Mailing Address - Fax:256-350-6466
Practice Address - Street 1:1874 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-350-0798
Practice Address - Fax:256-350-6466
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4385266OtherAETNA
AL630799536OtherCHAMPUS/TRICARE
AL000004302Medicaid
AL51004302OtherBCBS OF ALABAMA
AL630799536OtherCHAMPUS/TRICARE
ALC73935Medicare UPIN