Healthcare Provider Details

I. General information

NPI: 1235211582
Provider Name (Legal Business Name): GEORGE CHRISTOPHER KUTTERUF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: G C KUTTERUF MD

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 LINCOLN WAY SUITE 200
COEUR D ALENE ID
83814-2476
US

IV. Provider business mailing address

1607 LINCOLN WAY SUITE 200
COEUR D ALENE ID
83814-2476
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-5483
  • Fax: 208-667-5483
Mailing address:
  • Phone: 208-667-5483
  • Fax: 208-667-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM3978
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: