Healthcare Provider Details

I. General information

NPI: 1134551773
Provider Name (Legal Business Name): KENNETH DUVAL HUTCHINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 NW 10TH AVE
MIAMI FL
33136-1054
US

IV. Provider business mailing address

1851 NW 10TH AVE
MIAMI FL
33136-1054
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-2484
  • Fax:
Mailing address:
  • Phone: 305-545-2484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME 82184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: