Healthcare Provider Details

I. General information

NPI: 1659536092
Provider Name (Legal Business Name): ELIZABETH ANNE HUTCHINSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16763 MEADOWBROOK
HASLETT MI
48840-8869
US

IV. Provider business mailing address

16763 MEADOWBROOK
HASLETT MI
48840-8869
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-0321
  • Fax: 517-339-2452
Mailing address:
  • Phone: 517-339-0321
  • Fax: 517-339-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301030371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: