Michael Blacksmith, DO
Individual provider Active NPI Family Medicine Physician · Hazen, ND
NPI 1750355533 · NPPES record last updated May 14, 2013
Key facts
- NPI
- 1750355533
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 9158 (ND)
- Practice address
- 517 8TH Ave NE
Hazen, ND 58545-4638 - Phone
- (701) 748-2256
- Fax
- (701) 748-2257
- NPI assigned
- Feb 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9158 | ND | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9158 | ND | Yes |
Addresses
Primary practice location
517 8TH Ave NE
Hazen, ND 58545-4638
Mailing address
322 7TH Ave NW
Hazen, ND 58545-4108
Phone (701) 748-3623
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11992 | Medicaid | ND |
Other providers in Hazen, ND
- Nicholas Ryan Bakkum
- Anna Mae Batke
- Madison June Bennett
- Rhonda Biffert
- Kimberley Dawn Binstock
- Helma Brunmeier
- Michael Ralph Chase
- City of Hazen
- Coal Country Community Health Center
- Courtney Elizabeth Dean
All providers in Hazen, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.