Provider Demographics
NPI:1396891743
Name:HULL, MICHAEL SHANE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANE
Last Name:HULL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4900 S. MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:405-715-2022
Mailing Address - Fax:405-715-2905
Practice Address - Street 1:105 SO. BRYANT AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6330
Practice Address - Country:US
Practice Address - Phone:405-715-2022
Practice Address - Fax:405-715-2905
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4302207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200070260AMedicaid
OK200070260AMedicaid
OKP00774421Medicare PIN