Healthcare Provider Details

I. General information

NPI: 1568409522
Provider Name (Legal Business Name): MICHAEL JOHN HILTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 PARKWAY AVENUE SUITE E1
GREENSBORO NC
27401
US

IV. Provider business mailing address

411 PARKWAY AVENUE SUITE E1
GREENSBORO NC
27401
US

V. Phone/Fax

Practice location:
  • Phone: 336-895-1112
  • Fax: 336-895-1160
Mailing address:
  • Phone: 336-895-1112
  • Fax: 336-895-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ1828
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number9601205
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9601205
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: