Provider Demographics
NPI:1609845072
Name:HUNTER, MICHAEL MARK (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MARK
Last Name:HUNTER
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:253 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1501
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7606
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038150A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184666OtherANTHEM PROVIDER NUMBER
IN9397173OtherPHCS PID NUMBER
INHU91988035Medicaid
IN10825305OtherCAQH NUMBER
IN100262370Medicaid
IN10825305OtherCAQH NUMBER
IN9397173OtherPHCS PID NUMBER
INHU91988035Medicaid
IN000000184666OtherANTHEM PROVIDER NUMBER