Healthcare Provider Details

I. General information

NPI: 1699717678
Provider Name (Legal Business Name): MICHAEL A KUTMAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

3125 DR RUSSELL SMITH WAY
CARTHAGE MO
64836-7402
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-2300
  • Fax: 417-556-3625
Mailing address:
  • Phone: 417-455-0395
  • Fax: 417-455-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR8E70
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8E70
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: