Healthcare Provider Details

I. General information

NPI: 1891717716
Provider Name (Legal Business Name): EMIL D HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10945 N PORT WASHINGTON RD STE 201
MEQUON WI
53092-5078
US

IV. Provider business mailing address

10945 N PORT WASHINGTON RD STE 201
MEQUON WI
53092-5078
US

V. Phone/Fax

Practice location:
  • Phone: 262-292-3151
  • Fax: 262-643-4707
Mailing address:
  • Phone:
  • Fax: 414-282-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36557
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME173475
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number36557
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: