Provider Demographics
NPI:1376650895
Name:HUTJENS, KIRK J (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:J
Last Name:HUTJENS
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 1:1890 W COUNTY ROAD 419 STE 2010
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4402
Mailing Address - Country:US
Mailing Address - Phone:407-635-5560
Mailing Address - Fax:321-842-1176
Practice Address - Street 1:1890 W COUNTY ROAD 419 STE 2010
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4402
Practice Address - Country:US
Practice Address - Phone:407-635-5560
Practice Address - Fax:321-842-1176
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36423207R00000X
FLME132631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32429400Medicaid
BH5761817OtherDEA NUMBER
680800044Medicare ID - Type UnspecifiedMEDICARE PROVIDER
G78405Medicare UPIN