Provider Demographics
NPI:1023065950
Name:HUTTON, MAX CARLTON (MD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:CARLTON
Last Name:HUTTON
Suffix:
Gender:M
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:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:300 W WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2180
Practice Address - Country:US
Practice Address - Phone:517-841-1305
Practice Address - Fax:517-841-1306
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084981208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC810580OtherBCBSM GROUP
MI104776800Medicaid
MIP00224218OtherRR MEDICARE
MI4989434-10Medicaid
MIM95720008Medicare PIN
MIC810580OtherBCBSM GROUP
MIM50940051Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL