Provider Demographics
NPI:1306156476
Name:MICHELE A PASHKEVICH MD PA
Entity type:Organization
Organization Name:MICHELE A PASHKEVICH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASHKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-536-7300
Mailing Address - Street 1:1708 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7008
Mailing Address - Country:US
Mailing Address - Phone:870-536-7300
Mailing Address - Fax:870-535-7858
Practice Address - Street 1:1708 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7008
Practice Address - Country:US
Practice Address - Phone:870-536-7300
Practice Address - Fax:870-535-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113183001Medicaid
ARE04692OtherUPIN
AR5G779Medicare PIN
AR113183001Medicaid