MEDICARE: DR. RICK J HUTSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	36957	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050066043	OTHER		RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1073596896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICK J HUTSON M.D.

Provider Business Mailing Address
First Line	:	225 S EXECUTIVE DR
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4266
Country	:	US
Telephone Number	:	262-787-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	6308 8TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-5031
Country	:	US
Telephone Number	:	262-656-2011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	02/15/2009

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