Provider Demographics
NPI:1427022680
Name:HOTVET, MICHAEL H (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:HOTVET
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 1:323 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-3200
Mailing Address - Country:US
Mailing Address - Phone:605-256-6551
Mailing Address - Fax:605-256-6469
Practice Address - Street 1:323 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-3200
Practice Address - Country:US
Practice Address - Phone:605-256-6551
Practice Address - Fax:605-256-6469
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000283367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994182OtherBLUE CROSS SD
MN279G3HOOtherBLUE CROSS MN
SD5752663Medicaid
MN894223400Medicaid
SD5752663Medicaid
MN894223400Medicaid