Healthcare Provider Details

I. General information

NPI: 1790610368
Provider Name (Legal Business Name): ANDREW TUTTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE 100
KALAMAZOO MI
49007-5361
US

IV. Provider business mailing address

601 JOHN ST STE 100
KALAMAZOO MI
49007-5361
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-1222
  • Fax: 269-373-6270
Mailing address:
  • Phone: 269-373-1222
  • Fax: 269-373-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014113
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: