Healthcare Provider Details

I. General information

NPI: 1023065950
Provider Name (Legal Business Name): MAX CARLTON HUTTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WASHINGTON AVE SUITE 300
JACKSON MI
49201-2180
US

IV. Provider business mailing address

DEPARTMENT 272801 PO BOX 67000
DETROIT MI
48267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 517-841-1305
  • Fax: 517-841-1306
Mailing address:
  • Phone: 517-841-6913
  • Fax: 517-841-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301084981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: