Provider Demographics
NPI:1255399812
Name:HURT, MICHAEL DEAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
Last Name:HURT
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 1:7190 E KIERLAND BLVD # 294
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2657
Mailing Address - Country:US
Mailing Address - Phone:515-491-7755
Mailing Address - Fax:
Practice Address - Street 1:7190 E KIERLAND BLVD UNIT 924
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-0081
Practice Address - Country:US
Practice Address - Phone:515-491-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28371207L00000X
AZ36315207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6139329Medicaid
IA07305OtherWELLMARK BC BS
IA6139329Medicaid
IA07305OtherWELLMARK BC BS