Provider Demographics
NPI:1871502658
Name:FORD, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16221 SAINT VINCENT WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9072
Mailing Address - Country:US
Mailing Address - Phone:501-552-8150
Mailing Address - Fax:501-552-8199
Practice Address - Street 1:16221 SAINT VINCENT WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9072
Practice Address - Country:US
Practice Address - Phone:501-552-8150
Practice Address - Fax:501-552-8199
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC6201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114303001Medicaid
ARD04397Medicare UPIN
AR50710Medicare PIN