Basic Information
Provider Information
NPI: 1003013384
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSLEBER
FirstName: MICHAEL
MiddleName: FREDERICK
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4261 STOCKTON DRIVE SUITE LL100
Address2:  
City: NORTH LITTLE ROCK
State: AR
PostalCode: 72117
CountryCode: US
TelephoneNumber: 5019757456
FaxNumber: 5019781822
Practice Location
Address1: 9601 BAPTIST HEALTH DR STE 860
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722056375
CountryCode: US
TelephoneNumber: 5019757455
FaxNumber: 5019753631
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 10/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000XE7380ARN Allopathic & Osteopathic PhysiciansDermatology 
207ND0101XE7380ARY Allopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery

ID Information
IDTypeStateIssuerDescription
5AP05F18601ARMEDICARE PTANOTHER
19189400105AR MEDICAID


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