Basic Information
| Provider Information | |||||||||
| NPI: | 1104873587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORKMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9434 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658019434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178853888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 S NATIONAL AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658043634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178853888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 08/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 2002031632 | MO | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | E4419 | AR | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 2085N0700X | 2002031632 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | E4419 | AR | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 5N251 | 01 | AR | ARKANSAS FIRST SOURCE | OTHER | 18271 | 01 | MO | COX HEALTH PLANS UPI | OTHER | 4515931001 | 01 | MO | CIGNA HEALTHCARE | OTHER | 0214845 | 01 | WA | DEPARTMENT OF LABOR WA | OTHER | H00794 | 01 | MO | USPS (W/C) | OTHER | 05050016400 | 01 | MO | QUAL CHOICE | OTHER | 162037001 | 05 | AR | MEDICAID | 5N251 | 01 | AR | HEALTH ADVANTAGE | OTHER | 177827 | 01 | MO | BLUE CROSS/CHOICE | OTHER | 4188130001 | 01 | MO | CIGNA MEDICARE | OTHER | 5N251 | 01 | AR | ARKANSAS BC/BS | OTHER | 1602599 | 01 | MO | UNITED HEALTHCARE | OTHER | 203066607 | 05 | MO | MEDICAID |