Healthcare Provider Details

I. General information

NPI: 1326106956
Provider Name (Legal Business Name): THOMAS JOHN KUETTEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/24/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9556 STATE HIGHWAY 7, UNIT 2
WORCESTER NY
12197-1219
US

IV. Provider business mailing address

PO BOX 637
WORCESTER NY
12197-0637
US

V. Phone/Fax

Practice location:
  • Phone: 518-281-7987
  • Fax: 607-397-4052
Mailing address:
  • Phone: 607-397-4052
  • Fax: 607-397-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number166689
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: