Healthcare Provider Details

I. General information

NPI: 1174512214
Provider Name (Legal Business Name): STEVEN MARK HULSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MULLAN RD SUITE 103
MISSOULA MT
59808-5168
US

IV. Provider business mailing address

PO BOX 17527
MISSOULA MT
59808-7527
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8420
  • Fax:
Mailing address:
  • Phone: 406-728-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8033
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: