Healthcare Provider Details

I. General information

NPI: 1255334116
Provider Name (Legal Business Name): KEVIN WILLIAM HULSEBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HOSPITAL DR STE 201
HOLYOKE MA
01040-6614
US

IV. Provider business mailing address

2 HOSPITAL DR STE 201
HOLYOKE MA
01040-6614
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-8670
  • Fax: 413-534-0597
Mailing address:
  • Phone: 413-536-8670
  • Fax: 413-534-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number150499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: