MEDICARE: DANIEL JOHN HURLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601007212	MI

General Provider Information

NPI Number	:	1255739587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOHN HURLEY PA-C

Provider Business Mailing Address
First Line	:	31555 W 14 MILE RD STE 103
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31555 W 14 MILE RD STE 103
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1286
Country	:	US
Telephone Number	:	248-468-1889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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