Healthcare Provider Details

I. General information

NPI: 1063496123
Provider Name (Legal Business Name): PATRICK AARON KUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 ELECTRIC AVE SUITE 3
PORT HURON MI
48060-6588
US

IV. Provider business mailing address

PO BOX 610669
PORT HURON MI
48061-0669
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-1680
  • Fax: 810-985-1518
Mailing address:
  • Phone: 810-985-1884
  • Fax: 810-966-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301062024
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: