Healthcare Provider Details

I. General information

NPI: 1831133644
Provider Name (Legal Business Name): MICHAEL G. HUGHES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 TERRA CROSSING BLVD STE 375
LOUISVILLE KY
40245-5395
US

IV. Provider business mailing address

2401 TERRA CROSSING BLVD STE 375
LOUISVILLE KY
40245-5395
US

V. Phone/Fax

Practice location:
  • Phone: 502-912-8300
  • Fax: 502-912-8310
Mailing address:
  • Phone: 502-912-8300
  • Fax: 502-912-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number99098912A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number99098912A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44016
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number44016
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: