Healthcare Provider Details

I. General information

NPI: 1841403417
Provider Name (Legal Business Name): ANNA BARBARA KUTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N ELM ST STE 204
HINSDALE IL
60521-3644
US

IV. Provider business mailing address

907 N ELM ST STE 204
HINSDALE IL
60521-3644
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-9797
  • Fax: 630-627-9799
Mailing address:
  • Phone: 630-627-9797
  • Fax: 630-627-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036096288
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036096288
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: