Healthcare Provider Details

I. General information

NPI: 1134225568
Provider Name (Legal Business Name): MICHAEL JOHN HUTCHINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 GREAT NORTHERN LOOP STE 410
MISSOULA MT
59808-1749
US

IV. Provider business mailing address

2809 GREAT NORTHERN LOOP STE 410
MISSOULA MT
59808-1749
US

V. Phone/Fax

Practice location:
  • Phone: 406-493-1344
  • Fax: 406-830-3127
Mailing address:
  • Phone: 406-529-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11035
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: