Healthcare Provider Details

I. General information

NPI: 1396726113
Provider Name (Legal Business Name): MICHAEL E HURWITZ MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST YALE UNIVERSITY SCHOOL OF MEDICINE
NEW HAVEN CT
06510
US

IV. Provider business mailing address

333 CEDAR ST YALE UNIVERSITY SCHOOL OF MEDICINE
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-4822
  • Fax: 203-200-2099
Mailing address:
  • Phone: 203-200-4822
  • Fax: 203-200-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number048823
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: