Healthcare Provider Details

I. General information

NPI: 1073234886
Provider Name (Legal Business Name): LYDIA MARIE HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10327 GRAND RIVER RD STE 401
BRIGHTON MI
48116-6501
US

IV. Provider business mailing address

27180 MARTINDALE RD
NEW HUDSON MI
48165-9754
US

V. Phone/Fax

Practice location:
  • Phone: 800-787-5118
  • Fax:
Mailing address:
  • Phone: 248-916-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: