Healthcare Provider Details

I. General information

NPI: 1033663067
Provider Name (Legal Business Name): BRANDON ALAN KUTMAS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 07/09/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 44TH ST STE 5
ROCK ISLAND IL
61201-7187
US

IV. Provider business mailing address

4709 44TH ST STE 5
ROCK ISLAND IL
61201-7187
US

V. Phone/Fax

Practice location:
  • Phone: 309-306-1648
  • Fax: 309-213-9438
Mailing address:
  • Phone: 309-558-0258
  • Fax: 309-213-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: