MEDICARE: MICHAEL J. HUETHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	25976	AZ
2	207ND0900X	Dermatopathology Physician	25976	AZ
3	207NS0135X	Procedural Dermatology Physician	25976	AZ
4	207ND0101X	MOHS-Micrographic Surgery Physician	25976	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386647865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J. HUETHER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 37075
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85740-7075
Country	:	US
Telephone Number	:	520-887-3333
Fax Number	:	520-887-3344

Provider Business Practice Location Address
First Line	:	5980 N LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3535
Country	:	US
Telephone Number	:	520-887-3333
Fax Number	:	520-887-3344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	10/06/2022

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Directions to “ MICHAEL J. HUETHER M.D.” Practice Location

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