Provider Demographics
NPI:1093881211
Name:HUCKABEE, MICHAEL J (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:HUCKABEE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:516 W 14TH AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1216
Mailing Address - Country:US
Mailing Address - Phone:308-995-4431
Mailing Address - Fax:308-995-3247
Practice Address - Street 1:516 W 14TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1216
Practice Address - Country:US
Practice Address - Phone:308-995-4431
Practice Address - Fax:308-995-3247
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-02-26
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Provider Licenses
StateLicense IDTaxonomies
NE229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0423750001Medicare NSC
NER30748Medicare UPIN
NE272717Medicare ID - Type Unspecified