Healthcare Provider Details

I. General information

NPI: 1225051287
Provider Name (Legal Business Name): STEPHEN M KUTZ M.D., FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WELLS ST SUITE 102
WESTERLY RI
02891-2927
US

IV. Provider business mailing address

45 WELLS ST SUITE 102
WESTERLY RI
02891-2927
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-4499
  • Fax: 401-596-6360
Mailing address:
  • Phone: 401-596-4499
  • Fax: 401-596-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-10264
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number040007
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: