Healthcare Provider Details

I. General information

NPI: 1467969832
Provider Name (Legal Business Name): KUT TO THE CHASE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 EDMONDSON AVE STE 2
CATONSVILLE MD
21228-3357
US

IV. Provider business mailing address

PO BOX 21104
CATONSVILLE MD
21228-0604
US

V. Phone/Fax

Practice location:
  • Phone: 443-518-9075
  • Fax:
Mailing address:
  • Phone: 443-518-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number101749
License Number StateMD

VIII. Authorized Official

Name: CHASE LEVAR ISOM
Title or Position: OWNER/SPECIALIST
Credential: CERTIFIED HAIR LOSS
Phone: 443-518-9075