Provider Demographics
NPI:1952429680
Name:ANG POLAND, MICHELLE CHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CHUA
Last Name:ANG POLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:CHUA
Other - Last Name:ANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4077 ELM SPRINGS RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-3748
Mailing Address - Country:US
Mailing Address - Phone:479-927-2100
Mailing Address - Fax:479-927-2211
Practice Address - Street 1:4077 ELM SPRINGS RD STE 105
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-3748
Practice Address - Country:US
Practice Address - Phone:479-927-2000
Practice Address - Fax:479-927-2211
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047613207Q00000X
ARE-4817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199948001Medicaid
AR307340YJS9Medicare PIN