Provider Demographics
NPI:1891714879
Name:HUTTINGA, ROBERT NIXON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:NIXON
Last Name:HUTTINGA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S. LINCOLN
Mailing Address - Street 2:P.O. BOX 514
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850
Mailing Address - Country:US
Mailing Address - Phone:989-352-6500
Mailing Address - Fax:989-352-6273
Practice Address - Street 1:332 S. LINCOLN
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850
Practice Address - Country:US
Practice Address - Phone:989-352-6500
Practice Address - Fax:989-352-6273
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1152915130OtherBLUE CROSS # FOR GMC
MIM02890P15Medicare PIN