Healthcare Provider Details

I. General information

NPI: 1891807335
Provider Name (Legal Business Name): RICHARD HENRY KUTZ III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ROCK ROW STE 210
WESTBROOK ME
04092-4877
US

IV. Provider business mailing address

11 ROCK ROW STE 210
WESTBROOK ME
04092-4877
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-3446
  • Fax: 207-879-1646
Mailing address:
  • Phone: 207-775-3446
  • Fax: 207-879-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number018739
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number018793
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number018739
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number018739
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number018739
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number018739
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: