Healthcare Provider Details

I. General information

NPI: 1346321981
Provider Name (Legal Business Name): WALID MICHAEL KUTAYLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST SUITE 600
LINCOLN NE
68506-1283
US

IV. Provider business mailing address

1600 S 48TH ST SUITE 600
LINCOLN NE
68506-1283
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-3333
  • Fax: 402-483-3297
Mailing address:
  • Phone: 402-483-3333
  • Fax: 402-483-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number229363
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number22837
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: