Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | E4217 | AR |
NPI | 1033195649 |
---|---|
Provider Name | Mike C Umerah |
First Address | Little Rock, AR 72205-5302 |
Second Address | Little Rock, AR 72205-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 08/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158107001 | (05) | AR |
I43220 | (02) | |
P00322829 | RAILROAD MEICARE (01) | AR |