Provider Demographics
NPI:1447236393
Name:HEPNER, MICHAEL JULES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JULES
Last Name:HEPNER
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 1:35606 HUNTSMAN CT.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1386
Mailing Address - Country:US
Mailing Address - Phone:248-798-7674
Mailing Address - Fax:248-626-2248
Practice Address - Street 1:35606 HUNTSMAN CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1386
Practice Address - Country:US
Practice Address - Phone:248-798-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043746207RA0201X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B48049Medicare ID - Type Unspecified
B48049Medicare UPIN