Healthcare Provider Details

I. General information

NPI: 1376650895
Provider Name (Legal Business Name): KIRK J HUTJENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/07/2023
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 W COUNTY ROAD 419 STE 2010
OVIEDO FL
32765-4402
US

IV. Provider business mailing address

1890 W COUNTY ROAD 419 STE 2010
OVIEDO FL
32765-4402
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-5560
  • Fax: 321-842-1176
Mailing address:
  • Phone: 407-635-5560
  • Fax: 321-842-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36423
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME132631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: