Provider Demographics
NPI:1871676403
Name:OLTMANN, MICHAEL ADOLPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADOLPH
Last Name:OLTMANN
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 1901
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-1901
Mailing Address - Country:US
Mailing Address - Phone:870-673-7211
Mailing Address - Fax:870-672-6823
Practice Address - Street 1:1609 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3274
Practice Address - Country:US
Practice Address - Phone:870-673-7211
Practice Address - Fax:870-672-6823
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL28005207R00000X
ARE6212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100907002Medicaid
AR201481729Medicaid
AR2010478729Medicaid
AR129735729Medicaid
AR201479729Medicaid
AR201482729Medicaid
AR129734729Medicaid
AR201477729Medicaid
AR100904105Medicaid
AR136428729Medicaid
SCAA41388580Medicare PIN
AR201481729Medicaid
AR129735729Medicaid
AR043492Medicare Oscar/Certification
AR043489Medicare Oscar/Certification
AR040072Medicare Oscar/Certification
AR201479729Medicaid
AR136428729Medicaid
AR043457Medicare Oscar/Certification