Healthcare Provider Details

I. General information

NPI: 1164497301
Provider Name (Legal Business Name): HAKAN M. KUTLU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MADISON AVE SUITE 415
MORRISTOWN NJ
07960-6092
US

IV. Provider business mailing address

95 MADISON AVE SUITE 415
MORRISTOWN NJ
07960-6092
US

V. Phone/Fax

Practice location:
  • Phone: 973-644-3555
  • Fax: 973-644-3556
Mailing address:
  • Phone: 973-644-3555
  • Fax: 973-644-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number62792
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: