Provider Demographics
NPI:1336196625
Name:HADLEY, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HADLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-0514
Mailing Address - Country:US
Mailing Address - Phone:727-934-0150
Mailing Address - Fax:727-934-5001
Practice Address - Street 1:34876 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1918
Practice Address - Country:US
Practice Address - Phone:727-934-0150
Practice Address - Fax:727-934-5001
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HA666724OtherBLUE CROSS
CO06336531Medicaid
HA666724OtherBLUE CROSS
G63515Medicare UPIN
CO06336531Medicaid