Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036075844 | IL |
NPI | 1053395384 |
---|---|
Provider Name | Dr. Michael J Hussey |
First Address | Winfield, IL 60190-1295 |
Second Address | Winfield, IL 60190-1295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 29/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036075844 | (05) | IL |
206147219 | MEDICARE (INDIVIDUAL PTAN) (01) | IL |
F17895 | (02) |