Basic Information
Provider Information
NPI: 1255593034
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUTCHISON
FirstName: PAUL
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D., M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2160 S 1ST AVE
Address2:  
City: MAYWOOD
State: IL
PostalCode: 601533328
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2160 S 1ST AVE
Address2:  
City: MAYWOOD
State: IL
PostalCode: 601533328
CountryCode: US
TelephoneNumber: 7082169000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2008
LastUpdateDate: 04/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X036.127721ILN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RC0200X036.127721ILY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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