Provider Demographics
NPI:1891747184
Name:HULTON, MICHAEL ROGER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROGER
Last Name:HULTON
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 1:148 DIVISADERO ST
Mailing Address - Street 2:B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3268
Mailing Address - Country:US
Mailing Address - Phone:415-431-9070
Mailing Address - Fax:415-431-9070
Practice Address - Street 1:148 DIVISADERO ST
Practice Address - Street 2:B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3268
Practice Address - Country:US
Practice Address - Phone:415-431-9070
Practice Address - Fax:415-431-9070
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31306207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313060Medicaid
CA00A313062Medicare ID - Type Unspecified
F27621Medicare UPIN