Provider Demographics
NPI:1114980232
Name:HOOLEY, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:HOOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1983 SLOAN PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2087
Mailing Address - Country:US
Mailing Address - Phone:651-326-5700
Mailing Address - Fax:651-326-5715
Practice Address - Street 1:1983 SLOAN PL
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2087
Practice Address - Country:US
Practice Address - Phone:651-326-5700
Practice Address - Fax:651-326-5715
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN29354207Q00000X
CO051282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO025510OtherKAISER COMMERCIAL NUMBER
CO17603820Medicaid
CO17603820Medicaid
CO382501YK5YMedicare PIN