Healthcare Provider Details

I. General information

NPI: 1932599354
Provider Name (Legal Business Name): SBKT ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2015
Last Update Date: 12/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DES PERES RD SUITE 210
SAINT LOUIS MO
63131-2050
US

IV. Provider business mailing address

1000 DES PERES RD SUITE 210
SAINT LOUIS MO
63131-2050
US

V. Phone/Fax

Practice location:
  • Phone: 212-920-1382
  • Fax:
Mailing address:
  • Phone: 212-920-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN MICHAEL KUTNIK
Title or Position: ORTHOPEDIC HAND SURGEON
Credential: M.D.
Phone: 212-920-1382