Provider Demographics
NPI:1427431030
Name:HIGGINS, MICHAEL E SR (COA 00118)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:HIGGINS
Suffix:SR
Gender:M
Credentials:COA 00118
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KENNEDY DR
Mailing Address - Street 2:APT.405
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3326
Mailing Address - Country:US
Mailing Address - Phone:617-861-1562
Mailing Address - Fax:
Practice Address - Street 1:250 KENNEDY DR
Practice Address - Street 2:APT.405
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3326
Practice Address - Country:US
Practice Address - Phone:617-861-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAC.O.A.00118246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant