Healthcare Provider Details

I. General information

NPI: 1922748854
Provider Name (Legal Business Name): DAVID J KUTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

121 E FREEDOM WAY UNIT 511
CINCINNATI OH
45202-3487
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-3562
  • Fax:
Mailing address:
  • Phone: 717-877-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: