Healthcare Provider Details

I. General information

NPI: 1194806570
Provider Name (Legal Business Name): JEFFREY S KUTCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8273 GRAND RIVER RD 210
BRIGHTON MI
48114-9346
US

IV. Provider business mailing address

8273 GRAND RIVER RD STE 210
BRIGHTON MI
48114-9346
US

V. Phone/Fax

Practice location:
  • Phone: 866-974-2673
  • Fax: 866-939-2673
Mailing address:
  • Phone: 810-522-6080
  • Fax: 810-522-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number4301073973
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301073973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: