Provider Demographics
NPI:1902815558
Name:CHURCH, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:CHURCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1701 CLUB MANOR DR
Mailing Address - Street 2:STE 2B
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7401
Mailing Address - Country:US
Mailing Address - Phone:501-758-7352
Mailing Address - Fax:501-771-5014
Practice Address - Street 1:505 W PERSHING BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2157
Practice Address - Country:US
Practice Address - Phone:501-758-7352
Practice Address - Fax:501-771-5014
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC-7068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115824001Medicaid
AR115824001Medicaid
ARE87725Medicare UPIN
AR52874Medicare PIN