Healthcare Provider Details

I. General information

NPI: 1538618061
Provider Name (Legal Business Name): MICHELLE KUTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 W NATIONAL AVE STE 150
MILWAUKEE WI
53227-2145
US

IV. Provider business mailing address

10150 W NATIONAL AVE STE 150
MILWAUKEE WI
53227-2145
US

V. Phone/Fax

Practice location:
  • Phone: 414-431-0702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12870
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: