MEDICARE: RUSSELL KUTZELMAN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1518333467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL KUTZELMAN

Provider Business Mailing Address
First Line	:	7613 LITTLE RD
Second Line	:	SUITE 200D
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5525
Country	:	US
Telephone Number	:	727-494-7609
Fax Number	:	727-645-6997

Provider Business Practice Location Address
First Line	:	7613 LITTLE RD
Second Line	:	SUITE 200D
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5525
Country	:	US
Telephone Number	:	727-494-7609
Fax Number	:	727-645-6997

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

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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Directions to “ RUSSELL KUTZELMAN ” Practice Location

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