Provider Demographics
NPI:1134118961
Name:HUFFSTUTTER, SUE E (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:E
Last Name:HUFFSTUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W LUDINGTON AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2377
Mailing Address - Country:US
Mailing Address - Phone:231-843-8877
Mailing Address - Fax:231-845-0264
Practice Address - Street 1:409 W LUDINGTON AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2377
Practice Address - Country:US
Practice Address - Phone:231-843-8877
Practice Address - Fax:231-845-0264
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010590272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102817940Medicaid
MI0E361760Medicare ID - Type Unspecified
MI102817940Medicaid