MEDICARE: MILFORD BERTEN HUTCHINSON III MD

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	207V00000X	Obstetrics & Gynecology Physician	9419	SC

General Provider Information

NPI Number	:	1497747141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILFORD BERTEN HUTCHINSON III MD

Provider Business Mailing Address
First Line	:	1165 HIGHWAY 1 S STE 500
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-8966
Country	:	US
Telephone Number	:	803-438-0825
Fax Number	:	803-438-0817

Provider Business Practice Location Address
First Line	:	1165 HIGHWAY 1 S STE 500
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-8966
Country	:	US
Telephone Number	:	803-438-0825
Fax Number	:	803-438-0817

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	09/28/2018

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