Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301084981 | MI |
Y | 208600000X | Surgeon | 4301084981 | MI |
NPI | 1023065950 |
---|---|
Provider Name | Max Carlton Hutton |
First Address | Detroit, MI 48267-0001 |
Second Address | Jackson, MI 49201-2180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 17/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104776800 | (05) | MI |
4989434-10 | (05) | MI |
A84041 | (02) | |
C810580 | BCBSM GROUP (01) | MI |
P00224218 | RR MEDICARE (01) | MI |