1902213689 NPI number — HUTZEL WOMENS HEALTH SPECIALISTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902213689 NPI number — HUTZEL WOMENS HEALTH SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUTZEL WOMENS HEALTH SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902213689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29693
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-833-8800
Provider Business Mailing Address Fax Number:
313-833-8801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4727 SAINT ANTOINE ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-1461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-833-8800
Provider Business Practice Location Address Fax Number:
313-833-8801
Provider Enumeration Date:
07/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KMAK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
313-833-8800

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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