Provider Demographics
NPI:1174661987
Name:MICHAEL B HURWITZ MD INC
Entity Type:Organization
Organization Name:MICHAEL B HURWITZ MD INC
Other - Org Name:NEWPORT VEIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-631-4890
Mailing Address - Street 1:1901 WESTCLIFF DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5505
Mailing Address - Country:US
Mailing Address - Phone:949-631-4890
Mailing Address - Fax:949-631-4008
Practice Address - Street 1:3334 E COAST HWY
Practice Address - Street 2:SUITE 176
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2328
Practice Address - Country:US
Practice Address - Phone:949-631-4890
Practice Address - Fax:949-631-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48266208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21612OtherMEDICARE GROUP NUMBER
CAW21612OtherMEDICARE GROUP NUMBER
F51345Medicare UPIN