Provider Demographics
NPI:1457347361
Name:HUTZEL, MICHAEL R (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:HUTZEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 HEMPSTEAD TPKE STE 5
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5713
Mailing Address - Country:US
Mailing Address - Phone:516-605-0205
Mailing Address - Fax:516-579-3802
Practice Address - Street 1:4295 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-605-0205
Practice Address - Fax:516-579-3802
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004996213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP6446Medicare ID - Type Unspecified
NYU51393Medicare UPIN