Provider Demographics
NPI:1508031790
Name:HAKALA, MICHAEL C (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:HAKALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E PEDRO SIMMONS DR
Mailing Address - Street 2:C/O SECC
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-1347
Mailing Address - Country:US
Mailing Address - Phone:573-683-4409
Mailing Address - Fax:
Practice Address - Street 1:300 E PEDRO SIMMONS DR
Practice Address - Street 2:C/O SECC
Practice Address - City:CHARLESTON
Practice Address - State:MO
Practice Address - Zip Code:63834-1347
Practice Address - Country:US
Practice Address - Phone:573-683-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine