Basic Information
Provider Information
NPI: 1366630485
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HULEFELD
FirstName: ROBERT
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 MAIN ST
Address2:  
City: LEWISTON
State: ME
PostalCode: 04240
CountryCode: US
TelephoneNumber: 2077950111
FaxNumber: 2077955510
Practice Location
Address1: 300 MAIN ST
Address2:  
City: LEWISTON
State: ME
PostalCode: 04240
CountryCode: US
TelephoneNumber: 2077950111
FaxNumber: 2077955510
Other Information
ProviderEnumerationDate: 10/15/2007
LastUpdateDate: 11/30/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X017563MEY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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