Healthcare Provider Details

I. General information

NPI: 1619073681
Provider Name (Legal Business Name): MICHAEL L. HACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 INDUSTRIAL PARK RD
DAWSON SPRINGS KY
42408-2423
US

IV. Provider business mailing address

200 CLINIC DR
MADISONVILLE KY
42431-1661
US

V. Phone/Fax

Practice location:
  • Phone: 270-797-3521
  • Fax: 270-797-3292
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37313
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: