Basic Information
| Provider Information | |||||||||
| NPI: | 1902213689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUTZEL WOMENS HEALTH SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29693 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049152048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138338800 | ||||||||
| FaxNumber: | 3138338801 | ||||||||
| Practice Location | |||||||||
| Address1: | 4727 SAINT ANTOINE ST | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138338800 | ||||||||
| FaxNumber: | 3138338801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | KMAK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3138338800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | METRO WOMENS HEALTH II | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.