Healthcare Provider Details

I. General information

NPI: 1346462306
Provider Name (Legal Business Name): SCOTT KERMIT HUFFAKER D.O,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 MAIN ST SUITE 3
MARLETTE MI
48453-1100
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-4023
  • Fax: 989-635-5297
Mailing address:
  • Phone: 989-635-4023
  • Fax: 989-635-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101015361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: