Provider Demographics
NPI:1871607903
Name:CARNAHAN, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:CARNAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2353
Mailing Address - Country:US
Mailing Address - Phone:580-226-0543
Mailing Address - Fax:580-226-2284
Practice Address - Street 1:1104 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2353
Practice Address - Country:US
Practice Address - Phone:580-226-0543
Practice Address - Fax:580-226-2284
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100131180AMedicaid
OKE11808Medicare UPIN