Provider Demographics
NPI:1780620971
Name:KING, MICHAEL LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEWIS
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2215 JEFFERSON DAVIS DR.
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5222
Mailing Address - Country:US
Mailing Address - Phone:662-234-3303
Mailing Address - Fax:662-232-8936
Practice Address - Street 1:2215 JEFFERSON DAVIS DR.
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5222
Practice Address - Country:US
Practice Address - Phone:662-234-3303
Practice Address - Fax:662-232-8936
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS07509208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118175Medicaid
MSC47961Medicare UPIN