MEDICARE: DR. MICHAEL HURCHICK D.O.

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	207Q00000X	Family Medicine Physician	OT016454	PA
2	207Q00000X	Family Medicine Physician	OS018498	PA

General Provider Information

NPI Number	:	1336528892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HURCHICK D.O.

Provider Business Mailing Address
First Line	:	3 CRESCENT DR STE 100
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19112-1018
Country	:	US
Telephone Number	:	215-503-3300
Fax Number	:	215-503-3321

Provider Business Practice Location Address
First Line	:	3 CRESCENT DR STE 100
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19112-1018
Country	:	US
Telephone Number	:	215-503-3300
Fax Number	:

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

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	11/21/2018

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