Individual
MICHAEL DAVID HISCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7234
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011625400
—
MN
01
—
120L4HI
BLUE CROSS BLUE SHIELD
MN
01
—
264M1NO
BLUE CROSS BLUE SHIELD OF MN
MN
01
—
6404175
MEDICA
MN
01
—
HP39133
HEALTHPARTNERS
MN
Enumeration date
11/22/2006
Last updated
02/05/2018
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