Provider Demographics
NPI:1669891313
Name:HUGHES, MICHAEL FLOYD
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FLOYD
Last Name:HUGHES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30190 IVYWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9635
Mailing Address - Country:US
Mailing Address - Phone:651-257-1765
Mailing Address - Fax:
Practice Address - Street 1:30190 IVYWOOD TRL
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9635
Practice Address - Country:US
Practice Address - Phone:651-257-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1073656-1-HCBS253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency