Healthcare Provider Details

I. General information

NPI: 1346394061
Provider Name (Legal Business Name): TIMOTHY J KUTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950B N WYOMISSING BLVD
WYOMISSING PA
19610-1783
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-2490
  • Fax:
Mailing address:
  • Phone: 484-628-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD041055E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: