Provider Demographics
NPI:1811264260
Name:HULEY, MICHAEL (RSA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HULEY
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4210
Mailing Address - Country:US
Mailing Address - Phone:708-720-5392
Mailing Address - Fax:708-720-2035
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:219-617-0487
Practice Address - Fax:219-762-5717
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000300246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant