Healthcare Provider Details

I. General information

NPI: 1053552109
Provider Name (Legal Business Name): MICHAEL HSIEH M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-3215
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5042
  • Fax:
Mailing address:
  • Phone: 415-205-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberA82106
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD042607
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: