Provider Demographics
NPI:1194799478
Name:HUXFORD, MICHAEL R (MBA, MED, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:HUXFORD
Suffix:
Gender:M
Credentials:MBA, MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29W740 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1275
Mailing Address - Country:US
Mailing Address - Phone:630-926-8641
Mailing Address - Fax:
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:BOX 69
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-327-0989
Practice Address - Fax:773-327-1166
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0012312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer