Provider Demographics
NPI:1972553964
Name:HUMMER, MICHAEL G
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:HUMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:G
Other - Last Name:HUMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:711 W 38TH ST STE E1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1132
Mailing Address - Country:US
Mailing Address - Phone:512-477-5337
Mailing Address - Fax:512-682-6299
Practice Address - Street 1:711 W 38TH ST STE E1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1132
Practice Address - Country:US
Practice Address - Phone:512-477-5337
Practice Address - Fax:512-682-6299
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG78272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138502309Medicaid
TX820484Medicare ID - Type UnspecifiedMEDICARE NUMBER