Provider Demographics
NPI:1578851754
Name:MICHAEL HSU M.D. LLC
Entity Type:Organization
Organization Name:MICHAEL HSU M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHANG-CHI
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-824-4277
Mailing Address - Street 1:201 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5796
Mailing Address - Country:US
Mailing Address - Phone:904-824-4277
Mailing Address - Fax:904-824-4490
Practice Address - Street 1:201 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5796
Practice Address - Country:US
Practice Address - Phone:904-824-4277
Practice Address - Fax:904-824-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99434208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty