Provider Demographics
NPI:1740322890
Name:MICHAEL A. HUIE, MD, PHD PROF MEDICAL CORP
Entity type:Organization
Organization Name:MICHAEL A. HUIE, MD, PHD PROF MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HUIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-712-1200
Mailing Address - Street 1:1032 IRVING ST
Mailing Address - Street 2:STE 980
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2216
Mailing Address - Country:US
Mailing Address - Phone:650-712-1200
Mailing Address - Fax:
Practice Address - Street 1:617 MAIN ST
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1923
Practice Address - Country:US
Practice Address - Phone:650-712-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81413207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03356ZMedicare ID - Type Unspecified