Provider Demographics
NPI:1417052143
Name:HYATT, MAX TODD (DPM)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:TODD
Last Name:HYATT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5633
Mailing Address - Country:US
Mailing Address - Phone:336-375-6990
Mailing Address - Fax:336-375-0361
Practice Address - Street 1:1680 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9700
Practice Address - Country:US
Practice Address - Phone:336-375-6990
Practice Address - Fax:339-375-0361
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC416213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890803UMedicaid
0803UOtherBCBS
95363OtherMEDCOST
2433612Medicare ID - Type Unspecified
NC890803UMedicaid