Provider Demographics
NPI:1679154884
Name:HILDEBRANDT, MICHAEL KURT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KURT
Last Name:HILDEBRANDT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 PRINCE HALL DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3350
Mailing Address - Country:US
Mailing Address - Phone:248-342-2003
Mailing Address - Fax:
Practice Address - Street 1:29500 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3710
Practice Address - Country:US
Practice Address - Phone:734-261-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist