Provider Demographics
NPI:1902213689
Name:HUTZEL WOMENS HEALTH SPECIALISTS
Entity Type:Organization
Organization Name:HUTZEL WOMENS HEALTH SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:KMAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-833-8800
Mailing Address - Street 1:PO BOX 29693
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2048
Mailing Address - Country:US
Mailing Address - Phone:313-833-8800
Mailing Address - Fax:313-833-8801
Practice Address - Street 1:4727 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-833-8800
Practice Address - Fax:313-833-8801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO WOMENS HEALTH II
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-15
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN