Healthcare Provider Details

I. General information

NPI: 1508382375
Provider Name (Legal Business Name): PETER KUTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 N HOWARD AVE
ELMHURST IL
60126-2024
US

IV. Provider business mailing address

1437 NEWCASTLE LN
BARTLETT IL
60103-8936
US

V. Phone/Fax

Practice location:
  • Phone: 630-366-6681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209.016135
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017002961
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: