Healthcare Provider Details

I. General information

NPI: 1679894232
Provider Name (Legal Business Name): MICHELLE M HILL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575B BLUES LAKE PKWY
ROLLA MO
65401
US

IV. Provider business mailing address

1050 W 10TH ST
ROLLA MO
65401-2905
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-2007
  • Fax: 573-202-2455
Mailing address:
  • Phone: 573-364-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2018015073
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: