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General NPI Number Information
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NPI Number | 1487642492
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Entity Type | Individual
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Provider Name | MICHAEL J. HYMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 305 W JACKSON ST STE 303
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City | CARBONDALE
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State | IL
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Zip | 62901-1474
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Country | US
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Telephone | 618-351-9300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749267
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City | LOS ANGELES
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State | CA
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Zip | 90074-9267
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Country | US
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Telephone | 818-843-1700
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Fax | 818-843-0380
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A79203
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 036.144605
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License Number State | IL
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