Healthcare Provider Details

I. General information

NPI: 1487655197
Provider Name (Legal Business Name): WILLARD C HURLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E 1ST ST
DULUTH MN
55805-2107
US

IV. Provider business mailing address

915 E 1ST ST
DULUTH MN
55805-2107
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-5555
  • Fax:
Mailing address:
  • Phone: 218-249-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30460
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3460
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: