1548531551 NPI number — MICHAEL KUTKA, MD, LLC

Table of content: (NPI 1548531551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548531551 NPI number — MICHAEL KUTKA, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL KUTKA, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1548531551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 BROWN ST
Provider Second Line Business Mailing Address:
SUITE 502B
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01830-6778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-521-7600
Provider Business Mailing Address Fax Number:
978-521-7176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 BROWN ST
Provider Second Line Business Practice Location Address:
SUITE 502B
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830-6778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-521-7600
Provider Business Practice Location Address Fax Number:
978-521-7176
Provider Enumeration Date:
01/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KUTKA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-521-7600

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  217914 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2019655 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275530172 . This is a "PERSONAL NPI #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com