Provider Demographics
NPI:1801886015
Name:HUTCHINSON, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:HUTCHINSON
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 1:6351 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2545
Mailing Address - Country:US
Mailing Address - Phone:218-249-4500
Mailing Address - Fax:218-249-4555
Practice Address - Street 1:6351 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2545
Practice Address - Country:US
Practice Address - Phone:218-249-4500
Practice Address - Fax:218-249-4555
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN922797100Medicaid
MN49484HUOtherBCBSMN
CN1040901005OtherPREFERREDONE
109871P498OtherUCARE
CO11OtherTRICARE WEST
01-04755OtherMEDICA
WI34022400Medicaid
HP22645OtherHEALTHPARTNERS
HP22645OtherHEALTHPARTNERS
109871P498OtherUCARE
MN080004596Medicare ID - Type Unspecified