MEDICARE: CAROL L HULETT 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	CH042439	MI

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	:	1750485470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L HULETT MD

Provider Business Mailing Address
First Line	:	302 EL CAMINO REAL
Second Line	:	STE 5
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-2860
Country	:	US
Telephone Number	:	520-458-4335
Fax Number	:	520-452-2232

Provider Business Practice Location Address
First Line	:	1951 FRONTAGE RD
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4606
Country	:	US
Telephone Number	:	520-458-0650
Fax Number	:	520-459-7030

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	10/01/2010

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