Healthcare Provider Details

I. General information

NPI: 1619029824
Provider Name (Legal Business Name): KUTTERUF AND ROBINSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 LINCOLN WAY SUITE 200
COEUR D ALENE ID
83814-2462
US

IV. Provider business mailing address

1607 LINCOLN WAY SUITE 200
COEUR D ALENE ID
83814-2462
US

V. Phone/Fax

Practice location:
  • Phone: 203-667-5483
  • Fax: 208-667-7062
Mailing address:
  • Phone: 203-667-5483
  • Fax: 208-667-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM3978
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM3977
License Number StateID

VIII. Authorized Official

Name: JEAN M NELSON
Title or Position: BUSINESS OFFICE ADMINISTRATOR
Credential:
Phone: 208-667-5483