Provider Demographics
NPI:1851002695
Name:MEANS, MICHAEL BLAIN (SOIDC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BLAIN
Last Name:MEANS
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6800
Mailing Address - Country:US
Mailing Address - Phone:479-903-0135
Mailing Address - Fax:
Practice Address - Street 1:3D RECON BN
Practice Address - Street 2:UNIT 36180
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96389-6180
Practice Address - Country:US
Practice Address - Phone:479-844-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman