Healthcare Provider Details

I. General information

NPI: 1891809083
Provider Name (Legal Business Name): GREGORY KUTSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 ASTORIA BLVD
HOUSTON TX
77089-6041
US

IV. Provider business mailing address

2009 CAMPBELL PKWY
RICHARDSON TX
75082-4849
US

V. Phone/Fax

Practice location:
  • Phone: 281-929-6100
  • Fax:
Mailing address:
  • Phone: 469-878-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberEL061026
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM2683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: