Healthcare Provider Details

I. General information

NPI: 1184686115
Provider Name (Legal Business Name): MICHAEL J HOURIGAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RICKER RD
SALEM IL
62881-4263
US

IV. Provider business mailing address

4621 CJ HECK RD
SALEM IL
62881-3727
US

V. Phone/Fax

Practice location:
  • Phone: 618-548-3194
  • Fax: 618-548-1944
Mailing address:
  • Phone: 618-548-3031
  • Fax: 618-548-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-134876
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: