Provider Demographics
NPI:1104894955
Name:HUGGINS, MICHAEL BRADFORD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRADFORD
Last Name:HUGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3777
Mailing Address - Country:US
Mailing Address - Phone:336-651-8700
Mailing Address - Fax:336-651-8710
Practice Address - Street 1:1915 W PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3777
Practice Address - Country:US
Practice Address - Phone:336-651-8700
Practice Address - Fax:336-651-8710
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30268208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8944478Medicaid
NC2335816OtherMEDICARE PTAN, GROUP
NCP00630485OtherRR MEDICARE
NC207426BOtherMEDICARE PTAN, INDIVIDUAL
NC207426Medicare ID - Type Unspecified
NC2335816OtherMEDICARE PTAN, GROUP