Healthcare Provider Details

I. General information

NPI: 1013998715
Provider Name (Legal Business Name): MARK P. HUTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 CAHILL MAIN
FITCHBURG WI
53711-7109
US

IV. Provider business mailing address

1265 JOHN Q HAMMONS DR
MADISON WI
53717-1921
US

V. Phone/Fax

Practice location:
  • Phone: 608-661-7200
  • Fax:
Mailing address:
  • Phone: 608-251-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: