Provider Demographics
NPI:1750485470
Name:HULETT, CAROL L (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:HULETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:302 EL CAMINO REAL
Mailing Address - Street 2:STE 5
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2860
Mailing Address - Country:US
Mailing Address - Phone:520-458-4335
Mailing Address - Fax:520-452-2232
Practice Address - Street 1:1951 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4606
Practice Address - Country:US
Practice Address - Phone:520-458-0650
Practice Address - Fax:520-459-7030
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MICH042439207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ385927Medicaid
A79550Medicare UPIN
AZZ126581Medicare PIN