Individual
MICHAEL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
302 NE 14TH ST, LEON, IA 50144-1206
(641) 446-2383
Mailing address
11921 W STATE HIGHWAY YY, EAGLEVILLE, MO 64442-9193
(660) 373-2134
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A164712
IA
Other
Enumeration date
08/02/2021
Last updated
05/13/2022
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