Provider Demographics
NPI:1790559508
Name:HUCK, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 LOWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45744-7138
Mailing Address - Country:US
Mailing Address - Phone:740-525-4119
Mailing Address - Fax:
Practice Address - Street 1:4770 LOWELL HILL RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:OH
Practice Address - Zip Code:45744-7138
Practice Address - Country:US
Practice Address - Phone:740-525-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty