Healthcare Provider Details

I. General information

NPI: 1164678793
Provider Name (Legal Business Name): MICHAEL GREGORY HURTUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W 95TH ST SUITE 306
EVERGREEN PARK IL
60805-2735
US

IV. Provider business mailing address

2800 W 95TH ST BUSINESS DEVELOPMENT, 3N
EVERGREEN PARK IL
60805-2701
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-8500
  • Fax:
Mailing address:
  • Phone: 708-229-5420
  • Fax: 708-229-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036121842
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: