Provider Demographics
NPI:1518312388
Name:STUTZMAN, MICHAEL JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:STUTZMAN
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 1:111 COLCHESTER AVENUE, FLETCHER 311
Mailing Address - Street 2:UVM MEDICAL CENTER, DEPT OF MEDICINE
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-4350
Mailing Address - Fax:802-841-5368
Practice Address - Street 1:111 COLCHESTER AVENUE, FLETCHER 311
Practice Address - Street 2:UVM MEDICAL CENTER, DEPT OF MEDICINE
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-4350
Practice Address - Fax:802-841-5368
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
VT390200000X
VT060-0004551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program