Provider Demographics
NPI:1124687157
Name:MICHAEL, MINA MICHAEL KAMEL
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:MICHAEL KAMEL
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242198
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0021
Mailing Address - Country:US
Mailing Address - Phone:346-907-4805
Mailing Address - Fax:
Practice Address - Street 1:1355 DAVE WARD DR STE 102
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7082
Practice Address - Country:US
Practice Address - Phone:346-907-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0093284207R00000X
ARE-15635207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist