Healthcare Provider Details

I. General information

NPI: 1841785193
Provider Name (Legal Business Name): MICHAEL GLENN HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST STE 352
MIAMI FL
33175-3595
US

IV. Provider business mailing address

11760 SW 40TH ST STE 352
MIAMI FL
33175-3595
US

V. Phone/Fax

Practice location:
  • Phone: 786-428-1059
  • Fax: 786-428-1062
Mailing address:
  • Phone: 786-428-1059
  • Fax: 786-428-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME183759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: