1245206408 NPI number — ROMAN L KUTSY MD

Table of content: DR. SAADIQ MALIK OD (NPI 1881356871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245206408 NPI number — ROMAN L KUTSY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUTSY
Provider First Name:
ROMAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245206408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 112TH AVE NE STE D160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-3727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-637-2340
Provider Business Mailing Address Fax Number:
425-637-0036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 112TH AVE NE STE D160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-637-2340
Provider Business Practice Location Address Fax Number:
425-637-0036
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD00032822 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204D00000X , with the licence number: MD00032822 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1118462 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105487900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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