Healthcare Provider Details

I. General information

NPI: 1629089164
Provider Name (Legal Business Name): AHMED C.K. KUTTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 AVE A
KEARNEY NE
68847-3525
US

IV. Provider business mailing address

3015 AVENUE A
KEARNEY NE
68847-3525
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-7271
  • Fax: 308-865-2045
Mailing address:
  • Phone: 308-865-7271
  • Fax: 308-865-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number18789
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: