Healthcare Provider Details

I. General information

NPI: 1629047444
Provider Name (Legal Business Name): NANCY A HURCHIK-MUNACO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 ORCHARD LAKE ROAD SUITE 100
FARMINGTON HILLS MI
48336-2561
US

IV. Provider business mailing address

23800 ORCHARD LAKE ROAD SUITE 100
FARMINGTON HILLS MI
48336-2561
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-2420
  • Fax: 248-476-9709
Mailing address:
  • Phone: 248-476-2420
  • Fax: 248-476-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNH045873
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: