Healthcare Provider Details

I. General information

NPI: 1235169798
Provider Name (Legal Business Name): MICHAEL G. HUNT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12348 OLD TESSON RD SUITE 160
SAINT LOUIS MO
63128-2215
US

IV. Provider business mailing address

2754 MAIN ST
BRIDGEPORT CT
06606-5308
US

V. Phone/Fax

Practice location:
  • Phone: 314-467-3800
  • Fax:
Mailing address:
  • Phone: 203-275-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number051959
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4014
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: