Provider Demographics
NPI:1184686115
Name:HOURIGAN, MICHAEL J (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:HOURIGAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 CJ HECK RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-3727
Mailing Address - Country:US
Mailing Address - Phone:618-548-3031
Mailing Address - Fax:618-548-0596
Practice Address - Street 1:1201 RICKER RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-4263
Practice Address - Country:US
Practice Address - Phone:618-548-3194
Practice Address - Fax:618-548-1944
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-134876163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-000257OtherADVANCED PRACTICE NURSE