Provider Demographics
NPI:1093782583
Name:HUTCHFUL, KWEKU R (MD)
Entity Type:Individual
Prefix:
First Name:KWEKU
Middle Name:R
Last Name:HUTCHFUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-669-5944
Mailing Address - Fax:702-258-8542
Practice Address - Street 1:4475 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7826
Practice Address - Country:US
Practice Address - Phone:702-669-5944
Practice Address - Fax:702-258-8542
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV370022007OtherRAILROAD MEDICARE
NV2018508Medicaid
NV3102508Medicaid
H27334Medicare UPIN
NVES288ZMedicare PIN
NV36801Medicare ID - Type Unspecified