Provider Demographics
NPI:1417939778
Name:HURWITZ, MARTIN E (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:E
Last Name:HURWITZ
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 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-8600
Mailing Address - Fax:517-884-8650
Practice Address - Street 1:4600 S HAGADORN RD
Practice Address - Street 2:#405
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5306
Practice Address - Country:US
Practice Address - Phone:517-884-8600
Practice Address - Fax:517-884-8650
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035591207K00000X, 208000000X, 2080P0201X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417939778Medicaid
D90176Medicare UPIN
MI1417939778Medicaid
MI1417939778Medicaid
MI0H161036351Medicare ID - Type UnspecifiedU OF M