Healthcare Provider Details

I. General information

NPI: 1265438386
Provider Name (Legal Business Name): ALAN R KUTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD STE 810
MIAMI BEACH FL
33140-2800
US

IV. Provider business mailing address

1801 NE 123RD ST STE 405
NORTH MIAMI FL
33181-2884
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-5925
  • Fax: 305-674-5927
Mailing address:
  • Phone: 305-674-5925
  • Fax: 305-674-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME32823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: