Provider Demographics
NPI:1700970183
Name:HARDING, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HARDING
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 1:801 ENCINO PL NE STE C12
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2618
Mailing Address - Country:US
Mailing Address - Phone:505-247-4849
Mailing Address - Fax:505-247-4850
Practice Address - Street 1:801 ENCINO PL NE STE C12
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2618
Practice Address - Country:US
Practice Address - Phone:505-247-4849
Practice Address - Fax:505-247-4850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92241207RC0000X
NM92-241202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000F8557Medicaid
NM380884YWL7Medicaid
F32391Medicare UPIN
NMNM301407Medicare PIN
$$$$$$$$$MMedicare PIN
NM380884YWL7Medicaid
NM000F8557Medicaid
NMNM301408Medicare PIN