Provider Demographics
NPI:1164652673
Name:AKHUTINA, MARIA VLADIMIROVNA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VLADIMIROVNA
Last Name:AKHUTINA
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 1:3802 OAKWOOD MALL DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3016
Mailing Address - Country:US
Mailing Address - Phone:715-839-9280
Mailing Address - Fax:715-839-9348
Practice Address - Street 1:3802 OAKWOOD MALL DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3016
Practice Address - Country:US
Practice Address - Phone:715-839-9280
Practice Address - Fax:715-839-9348
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093468207R00000X
WI72998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine