Healthcare Provider Details

I. General information

NPI: 1427022680
Provider Name (Legal Business Name): MICHAEL H HOTVET CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 SW 10TH ST
MADISON SD
57042-3200
US

IV. Provider business mailing address

323 SW 10TH ST
MADISON SD
57042-3200
US

V. Phone/Fax

Practice location:
  • Phone: 605-256-6551
  • Fax: 605-256-6469
Mailing address:
  • Phone: 605-256-6551
  • Fax: 605-256-6469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000283
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: