Provider Demographics
NPI:1497821581
Name:HOPKINS, MICHAEL SHAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAYNE
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13504 HAINES AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4932
Mailing Address - Country:US
Mailing Address - Phone:505-235-2987
Mailing Address - Fax:
Practice Address - Street 1:2825 BROADBENT PKWY NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1627
Practice Address - Country:US
Practice Address - Phone:505-235-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-272208D00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG09700Medicare UPIN
NMH0786837Medicare ID - Type Unspecified