Provider Demographics
NPI:1912261322
Name:HUTZ, CATHERINE E C (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:E C
Last Name:HUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 US HIGHWAY 61 STE 340
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4141
Mailing Address - Country:US
Mailing Address - Phone:636-937-1545
Mailing Address - Fax:636-937-8995
Practice Address - Street 1:1400 US HIGHWAY 61 STE 340
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4141
Practice Address - Country:US
Practice Address - Phone:636-937-1545
Practice Address - Fax:636-937-8995
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1071441207V00000X
MN56923207V00000X
MO2016020752207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1912261322Medicaid
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MNH400095165Medicare PIN