Provider Demographics
NPI:1336528553
Name:HILLIE, MICHAEL DAVID JR
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:HILLIE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:JENNIFERS
Other - Last Name:NEYMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 CAMP FOUR JACKS RD
Mailing Address - Street 2:904 CAMP FOUR JACK ROAD
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2000
Mailing Address - Country:US
Mailing Address - Phone:228-383-8786
Mailing Address - Fax:228-207-4378
Practice Address - Street 1:904 CAMP FOR JACK ROAD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2000
Practice Address - Country:US
Practice Address - Phone:228-383-7579
Practice Address - Fax:228-207-4378
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care