Provider Demographics
NPI:1437531555
Name:MICHAEL R. HUTZEL, DPM, PLLC
Entity Type:Organization
Organization Name:MICHAEL R. HUTZEL, DPM, PLLC
Other - Org Name:LI HYPERBARIC WOUND CARE FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-448-4186
Mailing Address - Street 1:14 REEVES AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-1625
Mailing Address - Country:US
Mailing Address - Phone:516-448-4186
Mailing Address - Fax:
Practice Address - Street 1:14 REEVES AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1625
Practice Address - Country:US
Practice Address - Phone:516-448-4186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004996213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty