Provider Demographics
NPI:1639161078
Name:HAWKINS, MICHAEL C (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 W ANTELOPE DR STE 225
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1167
Mailing Address - Country:US
Mailing Address - Phone:801-479-0312
Mailing Address - Fax:801-479-0312
Practice Address - Street 1:1660 ANTELOPE DRIVE
Practice Address - Street 2:STE 225
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-479-0312
Practice Address - Fax:801-479-0312
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT500991-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
870680455OtherMHB
45974174905001OtherBCS
870680455A014OtherTRICARE
QM000070485OtherALTIUS
45974174905001OtherBCS
QM000070485OtherALTIUS
005587311Medicare ID - Type Unspecified
870680455OtherMHB