Healthcare Provider Details

I. General information

NPI: 1356034409
Provider Name (Legal Business Name): DANIELLE HURST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W. THIRTEEN MILE RD BEAUMONT-ROYAL OAK
ROYAL OAK MI
48073
US

IV. Provider business mailing address

2601 W. THIRTEEN MILE RD GME OFFICE-BEAUMONT HOSPITAL
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-5000
  • Fax:
Mailing address:
  • Phone: 608-471-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351051704
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: