Provider Demographics
NPI:1457390734
Name:MULLINS, MICHAEL SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:MULLINS
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 1:1661 AIRPORT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7951
Mailing Address - Country:US
Mailing Address - Phone:501-625-7500
Mailing Address - Fax:501-625-7777
Practice Address - Street 1:1629 AIRPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7951
Practice Address - Country:US
Practice Address - Phone:501-767-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0694207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128688001Medicaid
AR$$$$$$$$$OtherRAILROAD MEDICARE
AR5J930Medicare PIN
ARG18538Medicare UPIN