Healthcare Provider Details

I. General information

NPI: 1457416554
Provider Name (Legal Business Name): MORRIS KUTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3058 HIGHLANDS BY THE LAKE WAY #6
LAKELAND FL
33812-5044
US

IV. Provider business mailing address

102 S EVERS ST SUITE 104
PLANT CITY FL
33563-5403
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-1321
  • Fax:
Mailing address:
  • Phone: 813-754-7756
  • Fax: 813-754-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME005867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: