Healthcare Provider Details

I. General information

NPI: 1508819681
Provider Name (Legal Business Name): PATRICK MICHAEL HURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR SUITE 203
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

16024 WEATHERFIELD DR
NORTHVILLE MI
48168-2356
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-4897
  • Fax: 248-569-5226
Mailing address:
  • Phone: 734-420-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301063189
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: