Provider Demographics
NPI:1295762078
Name:HUNTLEY, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:HUNTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 969096
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-9096
Mailing Address - Country:US
Mailing Address - Phone:858-495-0971
Mailing Address - Fax:858-495-0991
Practice Address - Street 1:7592 METROPOLITAN DR
Practice Address - Street 2:STE 404
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4428
Practice Address - Country:US
Practice Address - Phone:619-325-1161
Practice Address - Fax:619-325-1717
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70722207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70722OtherMEDICAL LICENSE
E01391Medicare UPIN
CAWG70722CMedicare PIN