Provider Demographics
NPI:1245491380
Name:MICHEL, HARRY ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ANDRE
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:530 WEST ATKINS BLVD
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-0669
Mailing Address - Country:US
Mailing Address - Phone:870-295-5225
Mailing Address - Fax:870-295-4070
Practice Address - Street 1:530 ATKINS BLVD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-2113
Practice Address - Country:US
Practice Address - Phone:870-295-5225
Practice Address - Fax:870-295-4070
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4237207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120190001Medicaid
AR54959G940Medicare PIN
AR120190001Medicaid
AR54959G122Medicare PIN
AR54959G912Medicare PIN