MEDICARE: MR. MICHAEL THOMAS TUTKO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	RN587836	PA

General Provider Information

NPI Number	:	1225205560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL THOMAS TUTKO RN

Provider Business Mailing Address
First Line	:	1200 SUMMITT ST
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1544
Country	:	US
Telephone Number	:	412-664-1518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 SUMMITT ST
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1544
Country	:	US
Telephone Number	:	412-664-1518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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