Healthcare Provider Details

I. General information

NPI: 1083696488
Provider Name (Legal Business Name): WILLIAM ALVIN KUTNER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2005
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FAIRVIEW RD SUITE 230
MOORESVILLE NC
28117-9504
US

IV. Provider business mailing address

4601 PARK RD SUITE 300
CHARLOTTE NC
28209-3239
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2000
  • Fax:
Mailing address:
  • Phone: 704-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number30394
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: