Basic Information
| Provider Information | |||||||||
| NPI: | 1427673409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUTCHER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | TYLER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8904 EAGLEBROOK CT | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276177540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193492768 | ||||||||
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| Practice Location | |||||||||
| Address1: | 852 PERRY RD | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275027701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194465670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2020 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.