Provider Demographics
NPI:1417931023
Name:HURLY, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:HURLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20452
Mailing Address - Street 2:FML- CREDENTIALING
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-457-8180
Mailing Address - Fax:614-442-2414
Practice Address - Street 1:1801 W 32ND ST BLDG B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1528
Practice Address - Country:US
Practice Address - Phone:417-623-6330
Practice Address - Fax:417-623-3950
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8J02207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
220018351OtherTRAVELERS
MO700432206Medicaid
MO700432206Medicaid
005010120Medicare PIN