Provider Demographics
NPI:1386674984
Name:HUME, MICHAEL EDWARD (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:HUME
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 NORTH MERIDIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1035
Mailing Address - Country:US
Mailing Address - Phone:405-605-5415
Mailing Address - Fax:405-605-5310
Practice Address - Street 1:2512 NORTH MERIDIAN AVENUE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1035
Practice Address - Country:US
Practice Address - Phone:405-605-5415
Practice Address - Fax:405-605-5310
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA00281363A00000X
OKPA281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100187100AMedicaid
OKS07252Medicare UPIN
OK100187100AMedicaid