Provider Demographics
NPI:1538180591
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:PHARMACY
Authorized Official - Phone:608-310-9922
Mailing Address - Street 1:3506 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1703
Mailing Address - Country:US
Mailing Address - Phone:608-238-3106
Mailing Address - Fax:608-663-8074
Practice Address - Street 1:3506 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1703
Practice Address - Country:US
Practice Address - Phone:608-238-3106
Practice Address - Fax:608-663-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI7237-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33197000Medicaid
2112792OtherPK
WI33197000Medicaid