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General NPI Number Information
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NPI Number | 1578851754
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Entity Type | Organization
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Legal Business Name | MICHAEL HSU M.D. LLC
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 201 HEALTH PARK BLVD SUITE 107
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5796
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Country | US
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Telephone | 904-824-4277
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Fax | 904-824-4490
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Provider Business Mailing Address
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Address Line | 201 HEALTH PARK BLVD SUITE 107
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5796
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Country | US
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Telephone | 904-824-4277
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Fax | 904-824-4490
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL CHANG-CHI HSU
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Credential | M.D.
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Telephone | 904-824-4277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME99434
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License Number State | FL
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