Michelle Bardack
Individual provider Active NPI Family Medicine Physician · Albuquerque, NM
NPI 1811093073 · NPPES record last updated Mar 22, 2017
Key facts
- NPI
- 1811093073
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD20060797 (NM)
- Practice address
- 2400 Tucker Ave NE
Albuquerque, NM 87131-0001 - Phone
- (505) 272-1734
- Fax
- (505) 272-1736
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070822001496 | NM | Practitioner - Family Practice | 1850282641 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD20060797 | NM | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unm Medical Group, Inc. | Current |
Accepting new patients | |
| Unm Medical Group Inc | Current |
Accepting new patients | |
| Unm Hospital | Past | Accepting new patients | |
| University of New Mexico | Past | Accepting new patients | |
| Unm Medical Group Inc | Past | Accepting new patients | |
| DHHS, PHS, Naihs, Shiprock Hospital | Past | Accepting new patients |
Locations
933 Bradbury Dr SE
Ste 2222
Albuquerque, NM 87106
Phone (505) 272-1476
2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD20060797 | NM | Yes |
Addresses
Primary practice location
2400 Tucker Ave NE
Albuquerque, NM 87131-0001
Mailing address
933 Bradbury Dr SE Ste 2222
Albuquerque, NM 87106-4375
Phone (505) 272-3120
Other providers in Albuquerque, NM
- Fayette Lynn Barbour
- Jessica Barbour
- Lesley A Barbour
- Madia E Barbour
- Maribel Barboza
- Ana Maria Bardales
- Monica Czaja Bardon
- Tamas Bardos
- Elizabeth J. Bare
- James E. Bare
All providers in Albuquerque, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.