Healthcare Provider Details

I. General information

NPI: 1770614000
Provider Name (Legal Business Name): JEFFREY W HUOTARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W HIGHLAND RD STE 950
HOWELL MI
48843-2196
US

IV. Provider business mailing address

138 W HIGHLAND RD STE 950
HOWELL MI
48843-2196
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-2400
  • Fax: 888-258-0150
Mailing address:
  • Phone: 906-487-1710
  • Fax: 906-487-9421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301084067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: