Provider Demographics
NPI:1619972783
Name:HURLEY, CHRISTOPHER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:HURLEY
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 1:1417 S CLIFF AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1022
Mailing Address - Country:US
Mailing Address - Phone:605-322-8630
Mailing Address - Fax:605-322-8631
Practice Address - Street 1:1417 S CLIFF AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1022
Practice Address - Country:US
Practice Address - Phone:605-322-8630
Practice Address - Fax:605-322-8631
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3798207RG0100X
CAG88404207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6000342Medicaid
SD110227619Medicare PIN
F82797Medicare UPIN
SDS8279Medicare PIN