Basic Information
| Provider Information | |||||||||
| NPI: | 1447276167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | REX | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 COURT ST | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486619390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893458120 | ||||||||
| FaxNumber: | 9893458129 | ||||||||
| Practice Location | |||||||||
| Address1: | 640 COURT ST | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893458120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301069744 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 4301069744 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4324713 | 05 | MI | MEDICAID | 4232809 | 05 | MI | MEDICAID |