Healthcare Provider Details

I. General information

NPI: 1275530172
Provider Name (Legal Business Name): MICHAEL F KUTKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HIGHLAND AVE SUITE3-4A
NEWBURYPORT MA
01950-3872
US

IV. Provider business mailing address

21 HIGHLAND AVE SUITE3-4A
NEWBURYPORT MA
01950-3872
US

V. Phone/Fax

Practice location:
  • Phone: 978-462-8300
  • Fax: 978-462-8301
Mailing address:
  • Phone: 978-462-8300
  • Fax: 978-462-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number217914
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: