Provider Demographics
NPI:1609060722
Name:MICHAEL J. HUETHER, M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL J. HUETHER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUETHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-887-3333
Mailing Address - Street 1:PO BOX 37075
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-7075
Mailing Address - Country:US
Mailing Address - Phone:520-887-3333
Mailing Address - Fax:520-887-3344
Practice Address - Street 1:5980 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3535
Practice Address - Country:US
Practice Address - Phone:520-887-3333
Practice Address - Fax:520-887-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77048Medicare PIN