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NPI Code Detail

MEDICARE: MR. MICHAEL ANTHONY HUYCK RN

MEDICARE: MR. MICHAEL ANTHONY HUYCK RN
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
1163W00000XRegistered Nurse041408668IL
2363LF0000XFamily Nurse Practitioner209021549IL

General Provider Information

NPI Number : 1316595747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL ANTHONY HUYCK RN
Provider Business Mailing Address
First Line : 2301 HAINSWORTH AVE
Second Line :
City : NORTH RIVERSIDE
State : IL
Zip : 60546-1328
Country : US
Telephone Number : 773-621-7775
Fax Number :
Provider Business Practice Location Address
First Line : 3240 W DIVISION ST
Second Line :
City : CHICAGO
State : IL
Zip : 60651-2405
Country : US
Telephone Number : 312-413-7425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2019
Last Update Date : 09/07/2020

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