Healthcare Provider Details

I. General information

NPI: 1386729333
Provider Name (Legal Business Name): MICHAEL LOUIS CUTOLO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 GERONIMO DR
EL PASO TX
79925-3417
US

IV. Provider business mailing address

PO BOX 9006
EL PASO TX
79995-9006
US

V. Phone/Fax

Practice location:
  • Phone: 915-778-4691
  • Fax: 915-778-8416
Mailing address:
  • Phone: 915-778-4691
  • Fax: 915-778-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: