Healthcare Provider Details

I. General information

NPI: 1003039199
Provider Name (Legal Business Name): JULIE ANN HUTSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 N WELLNESS DR STE 180
HOLLAND MI
49424-8047
US

IV. Provider business mailing address

3290 N. WELLNESS DR. BLDG D STE#180
HOLLAND MI
49424
US

V. Phone/Fax

Practice location:
  • Phone: 616-738-4262
  • Fax: 616-738-4266
Mailing address:
  • Phone: 616-738-4262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301051148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: