Healthcare Provider Details

I. General information

NPI: 1902213689
Provider Name (Legal Business Name): HUTZEL WOMENS HEALTH SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 SAINT ANTOINE ST SUITE 304
DETROIT MI
48201-1461
US

IV. Provider business mailing address

PO BOX 29693
BELFAST ME
04915-2048
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-8800
  • Fax: 313-833-8801
Mailing address:
  • Phone: 313-833-8800
  • Fax: 313-833-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID C KMAK
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 313-833-8800