Provider Demographics
NPI:1932164555
Name:FLEMING, MICHAEL HAMILTON (AA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAMILTON
Last Name:FLEMING
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6455
Mailing Address - Country:US
Mailing Address - Phone:256-429-5050
Mailing Address - Fax:
Practice Address - Street 1:460 LANIER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1866
Practice Address - Country:US
Practice Address - Phone:256-319-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAA805367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4011019OtherBLUE SHIELD TENN
AL51524311OtherBCBS AL
AL051555239Medicaid
AL51524311OtherBCBS AL
AL051555239Medicare ID - Type UnspecifiedMEDICARE