=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801886015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID A HUTCHINSON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2005
-----------------------------------------------------
Last Update Date | 04/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6351 E SUPERIOR ST
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55804-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-249-4500
-----------------------------------------------------
Fax | 218-249-4555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6351 E SUPERIOR ST
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55804-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-249-4500
-----------------------------------------------------
Fax | 218-249-4555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 32656
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------