Provider Demographics
NPI:1770674228
Name:FLAX, MICHAEL GREG (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GREG
Last Name:FLAX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3120 LA MANCHA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104
Mailing Address - Country:US
Mailing Address - Phone:505-243-5116
Mailing Address - Fax:
Practice Address - Street 1:8120 CONSTITUTION PL NE
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-292-5534
Practice Address - Fax:505-292-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM8034207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23408Medicaid
NM23408Medicaid
D35626Medicare UPIN