Provider Demographics
NPI:1770614000
Name:HUOTARI, JEFFREY W (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:HUOTARI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:138 W HIGHLAND RD
Mailing Address - Street 2:STE 950
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2196
Mailing Address - Country:US
Mailing Address - Phone:906-487-1710
Mailing Address - Fax:906-487-9421
Practice Address - Street 1:138 W HIGHLAND RD
Practice Address - Street 2:STE 950
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2196
Practice Address - Country:US
Practice Address - Phone:517-545-2400
Practice Address - Fax:888-258-0150
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-06-16
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Provider Licenses
StateLicense IDTaxonomies
MI4301084067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00642888OtherRAIL ROAD MEDICARE
MIP00642888OtherRAILROAD MEDICARE
MICA3556OtherRAILROAD MEDICARE GROUP