Provider Demographics
NPI:1679575476
Name:MIKE FLINT ENTERPRISES INC
Entity type:Organization
Organization Name:MIKE FLINT ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:608-310-9922
Mailing Address - Street 1:1255 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3754
Mailing Address - Country:US
Mailing Address - Phone:608-255-9116
Mailing Address - Fax:608-255-9969
Practice Address - Street 1:1255 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3754
Practice Address - Country:US
Practice Address - Phone:608-255-9116
Practice Address - Fax:608-255-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9024-423336C0003X
WI0924-02183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33074800Medicaid
2126885OtherPK