Individual
MICHAEL CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
PMG KASEMAN BEHAVIORAL MEDICINE, 1325 WYOMING NE, ALBUQUERQUE, NM 87112
(505) 291-5300
(505) 291-5303
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD2005-0045
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41973836
—
NM
Enumeration date
10/03/2006
Last updated
03/18/2009
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